Hello, I am having a hard time understanding the global surgical package indicator XXX. Per CMS coding manual, the global concept does not apply to XXX procedures. Then the manual says that Many of the XXX procedures have inherent pre procedure, intra procedure and post procedure work performed each time the procedure is completed. My question is since the global concept does not apply to these procedure, can an E/M code be billed on the same day as an XXX procedure without use of a modifier since global concept does not apply? What seems to be throwing me off is the inherent pre procedure, intra procedure and post procedure information. I appreciate any guidance on this. Thanks