Global period data collection and possible future changes

November 6, 2018
CMS may consider revaluing the 10-day global procedures in the near future.
Coding Changes

Excerpted from page 40 of the October 2018 edition of AOA Focus.

As the Coding Experts have previously reported, over the past several years the Centers for Medicare & Medicaid Services (CMS) has grappled with the appropriate valuation of surgical services, which contain multiple office visits in the post-operative global period. CMS is concerned that a greater number of post-surgical visits have been included than are actually delivered by the surgeon or co-managing provider during the 10-day (minor surgery) or 90-day (major surgery) global period.

On July 1, 2017, CMS began requiring doctors who practice with more than 10 practitioners and who practice in certain states (Florida, Kentucky, Louisiana, Nevada, New Jersey, North Dakota, Ohio, Oregon or Rhode Island) to report CPT 99024 (postoperative follow-up visit) when the doctor provides a visit during the postoperative period for certain services. For doctors of optometry, this reporting would be done when the doctor is providing postoperative care to a patient after surgery. CMS only requires that the postoperative visits be reported with CPT 99024 for certain surgical services. Find a complete listing of the codes that trigger reporting in 2018.

CMS recently released data on the number of doctors who are complying with this requirement.

CMS estimates that there are 247 doctors of optometry who performed at least one of the 293 relevant global procedures and were affiliated with a tax identification number with 10 or more practitioners. Out of those doctors, approximately 158 reported the appropriate 99024 code (64% of the relevant doctors of optometry).

Through this data analysis, CMS has indicated that there is a very small number of postoperative visits reported using CPT code 99024 during 10-day global periods. CMS is considering whether this is an indication that many visits included in the valuation of 10-day global packages are not actually being furnished. Based on this analysis, CMS may consider revaluing the 10-day global procedures in the near future.

Doctors practicing in the states that are required to report and who have a practice with more than 10 practitioners should ensure that visits are being appropriately reported for all 10- and 90-day global procedures on the required codes. Codes that require this reporting include glaucoma surgery, cataract surgery, laser treatment of retina, removal of eyelid lesion, closure of tear duct opening and many more. All doctors of optometry should be aware of this effort and the early CMS findings as this will likely result in reimbursement changes in the near future.

Other important updates

Updated ICD-10 Codes

New ICD-10 codes went into effect on Oct. 1, 2018. A number of changes have been made that impact doctors of optometry, including the addition of new codes for malignant melanoma of the eyelids; paralytic ectropion of eyelids; mechanical lagophthalmos and more. The 2019 Codes for Optometry manual can be purchased from AOA Marketplace.

Corneal cross-linking coding

In the American Medical Association's (AMA) CPT coding guidance publication, CPT Assistant, information was included regarding the appropriate coding to report corneal cross-linking for both the procedure and the drug. CPT has clarified that Category III code 0402T, collagen cross-linking of cornea (including removal of the corneal epithelium and intraoperative pachymetry when performed), is reported for the operative procedure. However, when performed in the office of a doctor of optometry or another physician's office, "the supply of eye drops would be reported separately with code 99070," according to CPT Assistant. While this guidance was provided by AMA CPT, it was noted that coding for the procedure and the drug may vary based on payer.

More resources

AOA Coding Today is an online, comprehensive database that contains information in real time for CPT, ICD-10 and HCPCS coding and research. The website is tailored specifically to optometry, assists doctors and staff in correct reimbursement and compliance, and has an easy-to-use code diagnosis ability based on region. This exclusive member resource can assist you immediately with your coding questions.

If you have suggestions for how AOA can best support the coding needs of doctors of optometry, please contact Kara Webb, AOA's director for coding and regulatory policy, by email or call 703.837.1018.

Ask the coding experts

If you have any questions regarding Medical Records and Coding, please submit them to Coding Experts Submission Form and one of our coding experts will be in contact with you.
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