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  • In 2017, the Centers for Medicare and Medicaid Services(CMS) began collecting postoperative visit data from group practices in nine states. Since July 1, 2017 affected providers must report CPT code 99024 Postoperative visit for minor (10-day) and major (90-day) surgical procedures, through the usual process for filing claims.

    • States affected: Florida, Kentucky, Louisiana, Nevada, New Jersey, North Dakota, Ohio, Oregon and Rhode Island. (CMS encourages practitioners in other states to report postoperative visits even if they’re not required to.)
    • Practices affected: Groups of 10 more physicians and non-physician (MD, DO, OD, PA, NP) practitioners.
    • Ophthalmology related CPT codes: 11200, 11440-11446, 11640-11646, 12051-12057, 13151, 13152, 14040, 14041, 14060, 14061, 15120, 15260, 15576, 15730, 15769, 15773, 15820-15823, 17000, 17110, 17280-17286, 21172, 21340, 21385-21395, 21406-21408, 37609, 61330, 61333, 64612, 64615, 64742, 65091, 65093, 65101-65105, 65110-65114, 65125-65140, 65150-65155, 65175, 65235-65265, 65270-65286, 65290, 65400, 65420-65426, 65436, 65450, 65600, 65710-65756, 65770, 65772-65775, 65780-65782, 65785, 65810, 65815, 65820, 65850, 65855, 65860, 65865-65880,65900, 65920, 65930, 66020-66030, 66130, 66150-66172, 66174-66175, 66179, 66180, 66183, 66184, 66185, 66225, 66250, 66500-66505, 66600-66635, 66680, 66682, 66700-66740, 66761, 66762, 66770, 66820-66821, 66825, 66830, 66840-66940, 66982, 66984, 66985, 66986, 66989, 66991, 67005-67010, 67015, 67025, 67027, 67030, 67031, 67036-67043,67101-67105, 67107-67110, 67113, 67115, 67120-67121, 67141-67145, 67208-67218, 67220, 67227-67229, 67250-67255, 67311-67316, 67318, 67343, 67345, 67400-67414, 67420-67450, 67550-67560, 67570, 67700, 67710, 67715, 67800-67808, 67825-67835, 67840, 67850, 67880-67882, 67900, 67901-67908, 67909, 67911, 67912, 97914-67917, 67921-67924, 67930-67935, 67938, 67950, 67961-67966, 67971-37975, 68020, 68110-68130, 68135, 68320-68325, 68326-68328, 68330-68340, 68360-68362, 68371, 68400, 68420, 68440, 68500-68505, 68520, 68530, 68540-68550, 68700, 68705, 68720, 68745-67850, 68760-68761, 68770, 68801, 68810-68816 and 68840. Additional codes are included. Visit CMS’s Global Surgery Data Collection webpage for full list of reportable codes.

    Beginning in 2019, CMS may use the information collected, along with any other available data, to improve the accuracy of valuation for surgical services.

    How to report postoperative visits performed July 1, 2017 and after

    The CMS data-collection project applies to Medicare Part B patients only. You do not need to report visits for patients on other insurance or in Medicare Advantage plans. Tip: Test your system and billing services before July 1, 2017 to ensure your software and staff are ready.

    • Schedule only medically necessary postoperative visits with the physician.
    • Report only face-to-face postoperative care related to the surgery, including the surgical diagnosis (no phone calls).
    • Include the practitioner, beneficiary and date of service in the claim.
    • If your practice management system or clearing house won’t submit a CPT code without a charge, put in $0.01 and write it off.

    Who should report:

    • Teaching physicians should follow the usual CMS policies for reporting CPT code 99024 using the GC or GE modifier as appropriate.
    • Include visits to patients you see postoperatively, whether or not you performed the original surgery.
    • If you co-manage with other providers, both of you should report your postoperative visits, whether you share a practice or not.

    Applicable settings:

    • The practice setting does not matter. Include visits performed in the office, ED, hospital or skilled nursing facility.
    • Practices with offices in multiple states should report postoperative visits based on where you performed the surgery. (E.g., report postop visits in Washington if the patient received surgery in Oregon.)

    How to handle other services:

    • If you perform others exams during the global period, only bill for exams recognized as unrelated to postoperative care; append modifier -24.
    • You may also report postop visits for other codes, if desired.

    CMS has not yet announced the remittance-advice code associated with 99024.

    Background on the data-collection project

    The Medicare Access and CHIP Reauthorization Act of 2015 barred CMS from eliminating 10- and 90-day global surgical payments, which the agency deemed misvalued. Instead, the law authorized CMS to collect data on such services to review the valuation of surgical services from a representative sample of physicians.

    • CMS chose 293 CPT codes for the project (55 affecting ophthalmology), based on high use or allowed charges:
      • Performed by more than 100 practitioners and 10,000 times; OR
      • Procedures with allowed charges exceeding $10 million.
    • The AMA Relative Value-Scale Update Committee proposed this method. CMS originally wanted to survey all codes with 10- or 90-day global periods.
    • Data collection began Jan. 1, 2017.
    • CMS will use the collected information to look at the number and level of medical visits furnished during the global period, plus other items and services related to the surgery, as appropriate.

    Additional resources