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  • Starting Jan. 1, 2017, the Centers for Medicare and Medicaid Services will collect postoperative visit data from group practices in nine states. Starting July 1, 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 CPT codes: 11200, 11440, 11441, 11442, 11443, 12051, 12052, 13151, 13152, 14040, 14041, 14060, 14061, 15120, 15260, 15823, 17110, 17280, 17281, 17282, 17283, 37609, 64612, 64615, 65756, 65855, 66170, 66179, 66180, 66711, 66761, 66821, 66982, 66984, 67036, 67040, 67041, 67042, 67108, 67113, 67145, 67210, 67228, 67255, 67800, 67840, 67900, 67904, 67917, 67924, 68760, 68761, 68801, 68810 and 68840. See detailed listing below.

    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 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

    Integumentary CPT Code Description Global Period
    11200 Removal of skin tags, multiple, fibrocutaneous, tags, any area; up to and including 15 lesions 10 days
    11440 Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 0.5 cm or less 10 days
    11441 Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 0.6 to 1.0 cm 10 days
    11442 Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 1.1 to 2.0 cm 10 days
    11443 Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 2.1 to over 3.0 cm 10 days
    12051 Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less 10 days
    12052 Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm 10 days
    13151 Repair, complex, eyelids, nose, ears and/or lips; 1.1 cm to 2.5 cm 10 days
    13152 Repair, complex, eyelids, nose, ears and/or lips; 2.6 cm to 7.5 cm 10 days
    14040 Adjacent tissue transfer or rearrangement, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; 10 sq cm or less 90 days
    14041 Adjacent tissue transfer or rearrangement, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; 10.1 sq cm to 30.0 sq cm 90 days
    14060 Adjacent tissue transfer or rearrangement, eyelids, nose, ears and/or lips; defect 10 sq cm or less 90 days
    14061 Adjacent tissue transfer or rearrangement, eyelids, nose, ears and/or lips; defect 10.1 sq cm to 30.0 sq cm 90 days
    15120 Split-thickness autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 100 sq cm or less, or 1% of body area of infants and children (except 15050) 90 days
    15260 Full thickness graft, free, including direct closure of donor site, nose, ears, eyelids, and/or lips; 20 sq cm or less 90 days
    15823 Blepharoplasty, upper eyelid; with excessive skin weighting down lid 90 days
    17110 Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions 10 days
    17280 Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less 10 days
    17281 Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm 10 days
    17282 Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm 10 days
    17283 Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm 10 days
         
    Cardiovascular CPT code Description Global Period
    37609 Ligation or biopsy temporal artery 10 days
         
    Nervous System CPT code    
    64612 Chemodenervation of muscle(s); muscle(s) innervated by facial nerve (eg, for blepharospasm, hemifacial spasm); also known as Botox 10 days
    64615 Chemodenervation of muscle(s); muscle(s) innervated by facial, trigeminal, cervical spinal and accessory nerves, bilateral (eg, for chronic migraine) 10 days
         
    Eye and Ocular Adnexa CPT Code Description Global Period
    65756 Keratoplasty (corneal transplant); endothelial 90 days
    65855 Trabeculoplasty by laser surgery 10 days
    66170 Trabeculectomy ab externo in absence of previous surgery 90 days
    66179 Aqueous shunt to extraocular equatorial plate reservoir; external approach; without graft 90 days
    66180 Aqueous shunt to extraocular equatorial plate reservoir; external approach; with graft 90days
    66711 Ciliary body destruction; cyclophotocoagulation, endoscopic 90 days
    66761 Iridotomy/iridectomy by laser surgery (eg, for glaucoma) per session 10 days
    66821 Discussion of secondary membranous cataract (opacified posterior lens capsule and/or anterior hyaloid; laser surgery (eg, YAG laser) (1 or more stages) 90 days
    66982 Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification), complex, requiring devices or techniques not generally used in routine cataract surgery (eg, iris expansion device, suture support for intraocular lens, or primary posterior capsulorrhexis) or performed on patients in the amblyogenic developmental stage 90 days
    66984 Extracapsular capsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification) 90 days
    67036 Vitrectomy, mechanical, pars plana approach; 90 days
    67040 Vitrectomy, mechanical, pars plana approach; with endolaser panretinal photocoagulation 90 days
    67041 Vitrectomy, mechanical, pars plana approach; with removal of preretinal cellular membrane (eg, macular pucker) 90 days
    67042 Vitrectomy, mechanical, pars plana approach; with removal of internal limiting membrane of retina (eg, for repair of macular hole, diabetic macular edema), includes, if performed, intraocular tamponade (ie, air, gas, or silicone oil) 90 days
    67108 Repair of retinal detachment; with vitrectomy, any method, including, when performed, air or gas tamponade, focal endolaser photocoagulation, cryotherapy, drainage of subretinal fluid, scleral buckling, and/or removal of lens by the same technique 90 days
    67113 Repair of complex retinal detachment (eg, proliferative vitreoretinopathy, stage C-1 or greater, diabetic traction retinal detachment, retinopathy of prematurity, retinal tear of greater than 90 degrees), with vitrectomy and membrane peeling, including, when performed, air, gas, or silicone oil tamponade, cryotherapy, endolaser photocoagulation, drainage of subretinal fluid, scleral buckling, and/or removal of lens 90 days
    67145 Prophylaxis of retinal detachment (eg, retinal break, lattice degeneration) without drainage, 1 or more sessions; photocoagulation (laser or xenon arc) 90 days
    67210 Destruction of localized lesion of retina (eg, macular edema, tumors), 1 or more sessions; photocoagulation 90 days
    67228 Treatment of extensive or progressive retinopathy (eg, diabetic retinopathy), photocoagulation 10 days
    67255 Scleral reinforcement (separate procedure); with graft; also known as tutoplast 90 days
    67800 Excision of chalazion; single 10 days
    67840 Excision of lesion of eyelid (except chalazion) without closure or with simple direct closure 10 days
    67900 Repair of brow ptosis (supraciliary, mid-forehead or coronal approach) 90 days
    67904 Repair of blepharoptosis; (tarso) levator resection or advancement, external approach 90 days
    67917 Repair of ectropion; extensive (eg, tarsal strip operations) 90 days
    67924 Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) 90 days
    68760 Closure of the lacrimal punctum; by thermocauterization, ligation, or laser surgery 10 days
    68761 Closure of the lacrimal punctum; by plug, each 10 days
    68801 Dilation of lacrimal punctum, with or without irrigation 10 days
    68810 Probing of nasolacrimal duct, with or without irrigation 10 days
    68840 Probing of lacrimal canaliculi, with or without irrigation 10 days