CMS data collection on postoperative visits
Ask the Coding Experts, by Doug Morrow, O.D., Harvey Richman, O.D., Rebecca Wartman, O.D.
Excerpted from page 48 of the March 2017 edition of AOA Focus.
Over the past several years, the Centers for Medicare & Medicaid Services (CMS) has grappled with how to appropriately value codes with global periods. CMS is concerned that post-surgical visits are valued higher than visits that were furnished and billed separately.
In 2014, CMS attempted to do away with global periods entirely, but Congress intervened, which disallowed CMS to move forward with this elimination. Instead, Congress required CMS to develop a process to gather information needed to value surgical services from a sample of physicians. During the fall of 2016, CMS finalized its process for moving forward with this data collection effort.
While any revaluation of services will impact all doctors of optometry, for this data collection effort, CMS has indicated that only doctors in certain states with practices of a certain size will be required to report on the number of visits provided during the postoperative global period:
- New Jersey
- North Dakota
- Rhode Island
Doctors in these states are required, beginning July 1, 2017, to report CPT 99024 (postoperative follow-up visit) when the doctor provides a visit during the postoperative period. For doctors of optometry, this reporting would be done when the doctor is providing postoperative care to a patient after surgery. CMS is only requiring the post-operative visits be reported with CPT 99024 for certain surgical services.
See a list of services for which this reporting is required.
See information on which services have a global period AOA Coding Today.
CMS has indicated that doctors who are not required to report these codes because of the state they live in, or the size of their practice, are able to report voluntarily. CMS encourages doctors to voluntarily report on the services provided during the post-operative period. CMS has noted that if reporting is done voluntarily, the reporting should be done for all visits relating to all codes on the list of applicable codes.
In addition to this data collection, CMS will be performing a survey of practitioners to gather data on services furnished in the post-operative period. Ultimately, this data collection effort may result in revaluation of certain CPT codes. The AOA will be fully engaged in any revaluation that may occur to ensure services that doctors of optometry provide are appropriately valued.
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Evaluation and management (E/M) services are incredibly important in patient care, and it’s critical that optometry practices are aware of changes ahead. Meanwhile, the AOA and other leading physician organizations are pushing legislation that would halt Medicare payment cuts resulting from the changes.
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