The office of Inspector General released reports in the past years that cast doubt on the valuation of global surgical payments. In particular, these reports looked at the number and intensity of postoperative care services provided in orthopedics, cardiology and ophthalmology.
They found that the valuation of the postop care in some of the surgical payments was overvalued. That is, fewer and less intensive postop services were provided then CMS has valued into the global postop payment. CMS responded to this by proposing to eliminate the postop period in services with 10 and 90 global days and paying for it separately. However, Congress prohibited that.
In 2017, practitioners who work in groups of ten or more and provide certain surgical services and live in one of nine states will need to report to Medicare all of their postop visits that are provided in the hospital or in the outpatient setting. This doesn’t mean only surgical practices.
There are number of services on the list which can be done by primary care, urgent care or by other specialties. A group of ten practitioners means a group of any single or multi specialty practice. It doesn’t mean that there needs to be ten surgeons in a group. There could be one surgeon in a group of ten. Practitioners in this case includes physicians nurse practitioners and physician assistants.
The reporting mandate begins July 1, 2017. However, groups may elect to report at any time in 2017. Although only practitioners in the following states are required to report, CMS invites practitioners in all states to report. The states with mandated reporting are Florida, Kentucky, Louisiana, Nevada, New Jersey, North Dakota, Ohio, Oregon, and Rhode Island.
CMS selected services for reporting that were performed frequently and had a composite high dollar value. Groups should report the CPT code 99024 for any in-hospital or out patient services that are postoperative when that practitioner or that practitioners partner sees the patient in follow-up for a service that is on the list.
CMS released the list and you can download it here. Look for the highlighted words, “list of codes” and download the file. You can read in more detail about why CMS is doing this and how they have selected the codes on this CMS page.
UPDATE: CMS recently released a FAQ document about reporting post op visits. You can find it here.