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The CMS global surgical package includes Quizlet

The CMS global surgical package includes: b. the day before the day of surgery for major procedures. When an evaluation and management (E/M) service provided is for the purpose of deciding to perform a major surgical procedure, which is reported The services included in a global surgical package may be furnished in any service location. Visits to a patient in the intensive care or Critical Care Unit are also included when made by the surgeon. Critical Care Services 99291 - 99292 are not considered part of the global package and are reimbursed separately Under Medicare's global surgical package regulations, a physician may bill separately for: A. Supplies used during the surgical procedure B. Procedures performed after the surgery to minimize pain C. Diagnostic tests required to determine the need for surgery D. The removal of tubes, sutures, or catheter The CMS definition for global surgical package is the same as that for CPT surgical package. T or F. True. The CMS global surgical package includes the surgical procedure and a standard package of preoperative, intraoperative, and postoperative services. T or F OTHER QUIZLET SETS. Chapter 1 Phlebotomy and Healthcare Review. 20 terms. Medicare's way of limiting the time for recovery. IE amount of time that the surgical package is in effect. Most insurance providers have adopted this policy. During this period you cannot bill separately for anything related to the surgery. Generally, 90 days for major surgery, 10 for minor surgery and none for v minor procedures

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the postoperative period are included in the global surgical package as are E&M services related to complications of the surgery. Postoperative visits unrelated to the diagnosis for which the surgical procedure was performed may be reported separately on the same day as a surgical procedure with modifie The global surgical package, also called global surgery, includes all the necessary services normally furnished by a surgeon before, during, and after a procedure. Medicare payment for a surgical procedure includes the pre-operative, intra-operative, and post-operative services routinely performed by the surgeon or by members of the same group. As outlined in the Medicare Claims Processing Manual,. Pub. 100-4, chapter 12, section 40.1, CMS includes the following items/services in the global surgical package:. Preoperative visits after the decision is made to operate, beginning with the day before the day of surgery for major procedures and the day of surgery for minor procedures The global periods are maintained by CMS and are located in the Medicare Physician Fee Schedule. The Plan recognizes and agrees with the services that are included and excluded from the Global Surgical Package that are referenced in the Medicare Claims Processing Manual, Chapter 12- Physicians/Non-physician Practitioners

Global Surgical Package Components 2. The global surgical package comprises a host of responsibilities that include standard facility requirements of filling out all necessary paperwork involved in surgical cases (e.g. preoperative H&P, operative consent forms, preoperative orders). Additionally, the surgeon's packaged payment includes (at no. The global surgical package is a single payment for all care associated with a surgical procedure. The payment is based on three phases of a surgical procedure. 1. Preoperative evaluation. 2. Intra-operative procedure. 3. Postoperative care for either zero (0), ten (10), or ninety (90) days This is just one example of the procedures/services included in specific types of global surgical procedures, according to the NCCI Policy Manual for Medicare Services. 6. Global Periods The global period accompanies the global surgical package and further defines the services included in it — specifically, during the post-operative period

Medicare Global Surgery Rules define the rules for reporting E&M services with procedures covered by these rules. This section summarizes some of the rules. All procedures on the Medicare Physician Fee Schedule are assigned a global period of 000, 010, 090, XXX, YYY, ZZZ, or MMM. The global concept does not apply to XXX procedures. Th The global surgical package concept includes the pre-operative, intra-operative and post-operative services, and are considered included in the specific CPT code. The pre-operative stage includes: Local infiltration. Click to see full answer. Likewise, what is the postoperative period included in the surgical Global Package for major surgery

Global Package Standard Flashcards Quizle

  1. 40 - Surgeons and Global Surgery 40.1 - Definition of a Global Surgical Package 40.2 - Billing Requirements for Global Surgeries 40.3 - Claims Review for Global Surgeries 40.4 - Adjudication of Claims for Global Surgeries 40.5 - Postpayment Issues 40.6 - Claims for Multiple Surgeries 40.7 - Claims for Bilateral Surgerie
  2. UnitedHealthcare follows the Centers for Medicare and Medicaid Services (CMS) in regard to Global Days Values as set forth in the National Physician Fee Schedule (NPFS) Relative Value File, except as noted below. UnitedHealthcare also follows CMS in regard to services included in and excluded from the Global Surgical Package
  3. istrative Contractors (MACs) have separate edits. If a procedure has a global period of 000 or 010 days, it is the postoperative period are included in the global surgical package as are E&M services related to complications of the surgery. Postoperative visits unrelated to the diagnosis fo
  4. True or False. The CPT definition of surgical package and the CMS definition of surgical package are different. True. True or False. When two or more surgical procedures are performed at the same operative session, modifier -51 should be assigned to all of the procedure codes. False
  5. The global surgical package, also called global surgery, includes all necessary services normally furnished by a surgeon before, during, and after a procedure. Medicare payment for the surgical procedure includes the pre-operative, intra-operative and post-operative services routinely performed by the surgeon or by members of the same group.
  6. Care on the day of the surgery is included in the global period unless the decision to perform the surgery was made during the visit on this day. (See modifier -57). There are 92 days in the global surgical period beginning the day before the procedure, the day of the procedure, and the 90 days following it

SCHOTT TO PLUS® - Gas-tight encapsulation and high speed data transmission. Leading global supplier of highly reliable glass-to-metal components Chapter 7: Surgery Coding, Part 1 The global surgical package includes: a) Pre-procedural evaluation and management b) The procedure c) follow-up care: The global period is determined by: The standard of care: The following is an example of a diagnostic test not included in the global package: biops The surgical package includes the. operation, local infiltration, digital block or topical anesthesia, and normal uncomplicated postoperative care. Included in a global surgery policy and a surgical package is/are. digital block or topical anesthesia. The two-digit modifier -57 means. decision for surgery

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The CPT® global surgical package definition includes the following: local infiltration, metacarpal/metatarsal/digital block or topical anesthesia subsequent to the decision for surgery; one related E&M encounter on the date immediately prior to or on the date of the procedure (including history and physical The global surgical package, also called global surgery, includes all the necessary services normally furnished by a surgeon before, during, and after a procedure. Medicare payment for a surgical procedure includes the pre-operative, intra-operative, and post-operative services routinely performed by the surgeon or by members of the same group. The global period, or global surgical package, bundles all care typically related to surgical service into a single payment. The Centers for Medicare & Medicaid Services (CMS) defines the global period to include: Pre-operative visits after the decision is made to operate. For major procedures, this includes pre- operative visits the day before. CMS Surgical Package •All procedures on the Medicare Physician Fee Schedule are assigned a Global period of 000, 010, 090, XXX, YYY, or ZZZ. •Procedures with zero or ten day global period are considered minor. •Procedures with a 90 day global period are considered major procedures. -Decision for surgery E/M is separately payabl If you have heard me speak about the global surgical package you know how I define a major procedure. A major procedure is anything that you do on me! Sadly, neither CPT nor CMS accepts my definition. Global days are assigned in the Medicare Fee Schedule. Although CPT doesn't discuss global days, insurers and practices use these definitions

Split Post-Op Care and the Global Surgery Package. Medicare reimbursement for surgical procedures is based on a 'package' of care that includes preoperative, intraoperative and postoperative care. When the package of care is split between two or more physicians or other health care practitioners, claims must be submitted according to these. Many payers other than Medicare use this definition, as well. The global period refers to the length of time the global surgical package applies. The basic idea of the global surgical package is that services normally performed by a provider before, during, and after a procedure are included in the surgery code instead of being reported.

Best CPT INTEGUMENT TEST REVIEW Flashcards Quizle

  1. All of the above ANS: D Rationale: The Medicare approved amount for surgery includes the following services when furnished by the physician who performs the surgery. The services included in the global surgical package may be furnished in any setting, eg, in hospitals, ASCs, and physicians' offices
  2. • Question 6 4 out of 4 points The Global Surgical Package applies to services performed in what setting? Selected Answer: d. All of the above Correct Answer: d. All of the above Response Feedback: Rationale: The services included in the global surgical package may be furnished in any setting, including hospitals, ASCs, and physicians' offices. Visits to a patient in an intensive or critical.
  3. The Medicare physician fee schedule payment for surgical procedures includes all the services and visits that are part of the global surgery payment including when such surgical procedures may be fragmented. Subsequent Hospital Care visits (CPT codes 99231 - 99233) are not separately payable when included in the global surgery payment

If the provider is reporting the global maternity package, all postpartum visits are included in the global code. If the provider is not claiming the global maternity package, and is providing postpartum care only, report 59430 Postpartum care only (separate procedure). This code includes all after-delivery E/M visits related to the pregnancy The Centers for Medicare and Medicaid Services (CMS, Medicare) is the source of HCPCS Level II codes. Medicare also assigns a global surgical period (global days) indicator to all procedure codes on the Medicare Physician Fee Schedule Database (MPFSDB) these codes are included in the global package. Per CMS Observation is included with global surgical codes and not separately reimbursable unless: o Appropriate use of modifiers 24, 25 and 57 are utilized and o The surgeon meets all the criteria for the hospital observation code Refer to the UnitedHealthcare Medicare Advantage Global Days.

Surgical Package Cards Flashcards Quizle

5.8 Differentiate between surgical packages and separate procedures (now named the Centers for Medicare and Medicaid Services, or CMS) decided that the CPT codes would be the standard for physician which includes physicians as well as repre-sentatives from America's Health Insurance Plans (AHIP), CMS, the American Healt 2. All surgical laparoscopic, hysteroscopic or peritoneoscopic procedures include diagnostic procedures. Therefore, CPT code 49320 is included in CPT codes 38120, 38570- 38572, 43280, 43651-43653, 44180-44227, 44970, 47562-47570, 49321-49323, 49650-49651, 54690-54692, 55550, 58545-58554, 58660- 58673, and 60650 the Global Package Let‟s split the global package of the extracapsular cataract surgery; 66984 (allowable $742.38) 66984-56 Pre-operative service provided by the ophthalmologist doing the pre-operative work-up ($74.24) 66984-54 Surgery only, by the ophthalmologist performing surgery ($519.67 CPT Code for Suture Removal during Global Period If a patient comes for postoperative treatment such as Suture Removal during Global Period of a set of procedures (usually 10 days for minor surgical procedures such as laceration repairs, and 90 days for major surgical procedures), code the visit using CPT Code 99024, and there will be no problem

combination of services included in a single procedure code. global surgery rule. answer. combination of services included in a single procedure code. question. global period. answer. day surrounding a surgical procedure when all services relating to the procedure are considered part of the surgical package. question. separate procedure. CMS then issued a payment or a recoupment reflecting the aggregate performance compared to the target price. In Model 2, the episode of care included a Medicare beneficiary's inpatient stay in the acute care hospital, post-acute care, and all related services during the episode of care - 30, 60, or 90 days after hospital discharge In 1992, CMS developed the concept of the Global Surgical Package, which pays for surgical services with a single payment. The full description of services that are included in this payment is described in the Medicare Claims Processing Manual, Chapter 12, Section 40 and in a CMS Fact Sheet May 1, 2013. Billing for Fracture Care: Emergency Department vs. Physician/Orthopedic Office. The purpose of this article is to clarify claim submission guidelines for global fracture care services and provide clarification on submitting claims for split care (between an Emergency Department (ED) physician and another physician, such as an orthopedist) and splinting and cast application

HIM2300C Chapter 4 - Surgery Flashcards Quizle

test date, include: • Coding Guidelines for CM & PCS • Review CCS Exam Prep presentations 3. Consider taking the CCS Practice Exam 1-2 weeks prior to the exam to mimic the testing environment 4. Focus on weakest area What's covered? Part B covers 2 types of services. Medically necessary services: Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice. Preventive services: Health care to prevent illness (like the flu) or detect it at an early stage, when treatment is most likely to work best Weegy: According to the Medicare guidelines, a surgical package includes the treatment of complications by the same physician.User: 12. The predefined number of days before and after a surgical procedure are referred to as the _____ period A slightly different approach may be taken when Medicare patients are involved. Medicare has stated that a patient is a new patient if no face-to-face service was reported in the last three years

What services are included in the surgical Global Package

If the APRN is performing pre-operative examinations and post-operative E&M for surgical patients, this is included in the global surgical package for major surgery. The global surgical package is a fixed fee to cover all treatment and services related to the surgical procedure including pre-operative visits after the decision is made to. Surgery reimbursement includes payment for all related services and supplies that are routine and needed for the procedure. A global surgery service can be completed in any setting, including hospitals, doctor's offices, or an ambulatory surgery center. Medicare payment for procedures includes a variety of services, such as CMS Publication 100-02, Medicare Coverage Policy Manual, Chapter 7 - Home Health Services, Section 10.11 - Consolidated Billing, C. Relationship Between Consolidated Billing Requirements and Part B Supplies and Part B Therapies Included in the Baseline Rates That Could Have Been Unbundled Prior to HH PPS That No Longer Can Be Unbundled. finalizing a requirement to report postoperative visits furnished during 10- and 90-day global periods. However, rather than using the proposed set of G-codes for this reporting, CMS will require the use of CPT code 99024 - Postoperative follow-up visit, normally included in the surgical package, to indicate that an evaluation and management.

ACEP // Surgical Package FA

submitted a proposal to the Centers for Medicare and Medicaid Services (CMS) detailing the agency's plan for reinvesting federal funding made available through the American Rescue Plan Act (ARPA). The spending plan includes strategies that seek to CPC Practice Exam 1 Flashcards | Quizlet What is NOT included in CPT® surgical package? A Finally, the AAOS notes that the CMS proposed values would result in reimbursement levels for these extensive procedures on elderly patients, many of whom have significant comorbidities, that are lower than if the surgeons used their total global period time to provide multiple mid-level outpatient EIM services (992 13)

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A service/procedure that does not yet have a specific CPT code. True or False. Only members of the American Medical Association can request changes to CPT. False. A concise statement of symptoms, problems, condition, diagnosis, or other factor that is reason for the encounter defines: a. History of present illness Medicare includes the following services in the global surgery payment when provided in addition to the surgery: Pre-operative visits after the decision is made to operate. For major procedures, this includes pre- operative visits the day before the day of surgery. Post-surgical pain management by the surgeon

Your Quick Guide to the Global Surgical Package - AAPC

  1. •Prohibited items include, but are not limited to: -Calculators -Pagers/cell phones/electronic digital devices -Recording or photographic devices -Weapons -Briefcases/computer bags/handbags/purses -Drinks/snacks -No smoking 1
  2. CPT states that surgical procedures include the operation per se, local infiltration, metacarpal/digital block, or topical anesthesia when used, and normal, uncomplicated follow-up care. Radiological interpretations are not listed as part of the surgical package, and therefore, can be coded separately when performed and documented appropriately
  3. Not all medical services are associated with financial charges. Some procedures are bundled into an overarching service. For instance, the simple closer of an incision made by a healthcare provider is considered an integral part of the incision procedure, while the simple closer of a laceration due to trauma, is considered a surgical procedure in its own right
  4. Surgical package . Separate procedure . National Correct Coding Initiative (NCCI) Modifier usage . Surgical coding . Objectives . 1. Surgery Overview . a. Describe the organization of the surgical section in CPT . b. List components of a surgical package . c. Distinguish between the CPT definition of surgical package and Medicare definition . d
  5. Surgical Coding Background. Directed by a nationally known surgical coding expert. Decades of experience in surgical coding for academic and private surgical subspecialty practices. Team of certified surgical coders each with a focus on particular surgical specialties. Experience in coding for surgeons in 49 states and at 60 medical schools
  6. 1.Hospitals have recognized universally that pharmacists must be in charge of drug product acquisition, distribution, and control. 2.Hospital pharmacy departments assume a major role in patient safety. 3.Hospital pharmacy departments assume a major role in promoting rational drug therapy
  7. Introduction The global surgical package is an all-inclusive package associated with a procedure. The global surgery package for a major procedure includes a preoperative period (one day prior to the date of surgery), intraoperative care (the day of the surgery), and a postoperative period (

Included in a global surgery policy and a surgical package is/are: Postoperative visits in and out of the hospital, and digital block or topical anesthesia. A clean claim: Is subject to medical review with attached information or forwarded simultaneously with electronic medical claim records 3/9/2021 update: The AMA issued an errata and technical correction document, and confirmed that the terms the global package does not define major and minor procedures. It stated, The classification of surgery into minor or major is based on the common meaning of such terms when used by trained clinicians, similar to the use of the term. E/M Service: Global Surgery Denials. The global days of a surgery are determined by CMS. As part of the Medicare Physician Fee Schedule database (MPFSDB), the codes all include their global information. Please check the website for any surgical code that might cause your claim to deny

Global Surgery Modifiers 24,25,57,58,59,78,79 - Billing

  1. Medicare Surgical Guidelines • Minor surgical procedures - 0-10 day global10 day global - Include same day services • Major surgical procedures - Preoperative beginning the day before, the day of surgery - 90 day global - Related post op 17 pp - Post surgical pain management by surgeon - Any related supplies, services, or.
  2. -22 Increased Procedural Services Service provided was significantly greater than the service described in the CPT code. Record must contain documentation that substantiates that the service was unusual in some way. Must include a special report. Modifier -22 is valid for codes with global periods of 0, 10 or 90 days
  3. Medicare - Bundled Services/Supplies - routinely, injection.global surgical package by Lori There are a number of services/supplies that are covered under Medicare and that have HCPCS codes, but they are services for which Medicare bundles payment into the payment for other related services

RVUS are determined by looking at three components: The work of the physician. Expenses incurred by the hospital or practice. The cost of malpractice insurance premiums. The work of the physician is the wRVU. When you add the other two elements in, all three combined equal your total RVU CPT & HCPCS Coding True or False. Anesthesia services are reimbursed based in part on the amount of time anesthesia is administered. The anesthesia code for the most complex procedure is assigned when multiple procedures are performed during the same operative session under the same type of anesthesia Evaluation and management services performed the same day as a 90day global medical or surgical - service will be denied as included in the global surgical package, unless the service consisted of a decision for surgery and is indicated with modifier 57

CPT CODE and Description CPT 99201 Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: a problem focused history; a problem focused examination; and straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualifie ChiroCode.com for Chiropractors CMS 1500 Claim Form Code-A-Note - Computer Assisted Coding Codapedia.com - Coding Forum Q&A CPT Codes DRGs & APCs DRG Grouper E/M Guidelines HCPCS Codes HCC Coding, Risk Adjustment ICD-10-CM Diagnosis Codes ICD-10-PCS Procedure Codes Medicare Guidelines NCCI Edits Validator NDC National Drug Codes NPI Look-Up. CPT CODE AND Description. 17311 - Mohs micrographic technique, including removal of all gross tumor, surgical excision of tissue specimens, mapping, color coding of specimens, microscopic examination of specimens by the surgeon, and histopathologic preparation including routine stain(s) (eg, hematoxylin and eosin, toluidine blue), head, neck, hands, feet, genitalia, or any location with. procedure codes and description 15822 blepharoplasty, upper eyelid; 15823 blepharoplasty, upper eyelid; with excessive skin weighting down lid 67900 repair of brow ptosis (supraciliary, mid-forehead or coronal approach) 67901 repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) 67902 repair of blepharoptosis; frontalis muscle techniqu Billed amount: It is the Amount charged for each service performed by the provider. In other words it is the total charge value of the claim. The billed amount for a specific procedure code is based on the provider. It may vary from place to place. It is not commo

If a code description includes the term separate procedure, if that procedure is in the same anatomic area as a more comprehensive procedure (for example, lyse of adhesions followed by a colectomy) only the more comprehensive procedure, the colectomy, is reported. *This response is based on the best information available as of 2/14/19 An example of this is surgical comanagement: If a surgeon is identified as the attending of record, they are responsible for postoperative management of the patient, including discharge services. 4,5 Providers in a different group or specialty report 99231-99233 for their medically necessary care 2022 Proposed ASC Payment Rule Released. 7/20: CMS has released the 2022 proposed payment rule for ASCs and hospital outpatient departments (HOPD).. Benchmarking Q2 Data Submission Now Open. 7/1: Data submission for Q2 of ASCA's 2021 Clinical & Operational Benchmarking Survey is now open and will close on July 31.. Important Dates in July. 7/1: Submit data for the ASCQR Program and Q2.

CMS vs. CPT® - AAPC Knowledge Cente

  1. The 1997 guidelines allow providers to document the status of three chronic diseases in place of the four HPI elements. The CMS reference guide to the 1997 guidelines can be found here. Review of systems - ROS is an inventory of positive and negative systems that describe the patient's condition. These systems are defined by the guidelines as
  2. This differs from the customary zero, 10, 90 global time followed for surgical procedures. CPT has some general coding rules that coders should follow closely when using a package code (i.e., 59400, 59410, and 59610) CPT does not specify that a physician must provide a certain number of visits to use the global OB package
  3. e how much to pay for your hospital stay. Rather than pay the hospital for each specific service it provides, Medicare or private insurers pay a predeter
  4. or procedures) and the 90-day post-op period (for most major procedures). Almost all services, supplies, wound management, and follow-up visits related to the procedure are included in the global surgery payment. The discharge summary also is part of the global surgery package
  5. In contrast, services provided to Medicare beneficiaries in CAHs are reimbursed at 101% of their reasonable costs (Medicare Claims Processing Manual, Chapter 3, §30.1.1, 2014). When billing for services furnished in a provider-based department, the hospital is generally paid only for the facility or technical component of the services, which.

Medicare's mandate: Medicare is a federally administered insurance program that Americans pay into throughout our working lives and enroll in after they retire or in case of a serious disability. Modifiers Pertaining to Surgery or Services within the Global Period Modifiers assure that the carrier will give consideration to the special circumstances that may affect payment. Omitting modifiers may result in payment denials. If a review is requested on a denied service, the appropriate modifier must be included with the who performs the surgery. The services included in the global surgical package may be furnished in any setting, e.g., in hospitals, Ambulatory Medical Coding I Flashcards | Quizlet Apr 02, 2018 뜀 A medical coding audit is a process that includes internal or external reviews of medical coding and billing accuracy, procedures or policies i Services for Individuals Age 65 or Older in an Institution for Mental Disease (IMD) Services in an intermediate care facility for Individuals with Intellectual Disability. State Plan Home and Community Based Services- 1915 (i) Self-Directed Personal Assistance Services- 1915 (j) Community First Choice Option- 1915 (k) TB Related Services

CPT Code Description Appendectomy Code Family 44950 Appendectomy 44955 Appendectomy; when done for indicated purpose at time of other major procedure (not as separate procedure) (List separately in addition to code for primary procedure) 44960 Appendectomy; for ruptured appendix with abscess or generalized peritonitis 44970 Laparoscopy, surgical, appendectomy When an HCPCS are divided in two levels. Level I codes are commonly referred to as CPT codes because they belong to the Current Procedural Terminology (CPT) administered by the American Medical Association (AMA). Commercial health insurance companies use CPT codes, and refer to them as such, generally following AMA guidelines for their use

Billing Guide and Policy: Effective January 1, 2010, procedure consultation codes were no longer recognized for Medicare Part B payment. As explained in CR 6740, Transmittal 1875, Revisions to Consultation Services Payment Policy, issued on December 14, 2009, physicians shall code patient evaluation and management visits with E/M codes that represent where the visit occurs and that identify. Intermediate and complex repair procedures performed initiate a 10-day global period. CPT guidelines define standards for preoperative and postoperative services that are included in the surgical package as: E/M service(s) subsequent to the decision for surgery on the day before and/or day of surgery (including history and physical The Association of periOperative Registered Nurses (AORN) is the leader in advocating for excellence in perioperative practice and healthcare. We unite and empower perioperative nurses, healthcare organizations, and industry partners to support safe surgery for every patient, every time CMS and TJC publish a manual, Specifications Manual for National Hospital Inpatient Quality Measures, that describes and defines criteria for each Core Measure in detail and also includes: • Reporting and analysis of Core Measures data • Global National Hospital Inpatient Quality Measures which include: -Emergency Department -Immunization Services Included in the Global Surgical Package are not separately reportable. According to the AAPC, a clear understanding of the differences between the rules pertaining to coding, billing, and reimbursement is necessary to know when unbundling can turn potentially problematic In actuality, the total global period is 11 days because the 10-day countdown begins the day after surgery. The advent of the new the global period changes the classification of the procedure from major to minor. The Centers for Medicare and Medicaid Services regulations package payment of the office visit with that of the minor procedure