Postoperative Visits: The Importance of CPT 99024

Current Procedural Terminology (CPT) code 99024 is defined as a “postoperative follow-up visit, normally included in the surgical package, to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) related to the original procedure.”¹ 

Value of our procedures:When the value of any procedure is determined, the number of global postoperative visits that typicallyfollow is taken into consideration.  For example, the value of CPT 11750, (Excision of nail and nail matrix, partial or complete, for permanent removal) that may be used for ingrown or deformed nails was determined with the assumption that we are providing one postoperative visit within the 10-day global period. Stated more crudely, we get paid more for CPT 11750 If the Centers for Medicare and Medicaid Services (CMS) know that we are providing a “free” global visit.

How do they know? The Relative Value Update Committee (RUC)of the American Medical Association and the Specialty Society Relative Scale Update Committeeprovide input regarding what is typical in practice. Ultimately, however, the Centers for Medicare and Medicaid Services (CMS) only knows for sure that a global visit was provided when one submits CPT 99024.

The problem: In the 2019 Medicare Part B Physician Fee Schedule Proposed Rule, CMS published its concern that postoperative global visits are occurring so infrequently that they may lower the values associated with procedures that carry a global period.2 From the CMS perspective, if the global visit is not occurring, it should not be included in the value of the procedure. This can lead to the assignedvalue of our procedures being reduced.

What can we do? The biggest fear is that CMS is working with bad information.  This would be the case if these postoperative global visits are, in fact, occurring but are not being reported. Some may not report these visits because they think it wastes time to submit a claim with a $0 charge. Some may even lose money by submitting these visits if they have to pay a clearinghouse or some other entity every time they submit a claim. 

The most important thing that we as podiatrists can do right now is to submit CPT 99024 every time we perform a postoperative global visit during the global period following a procedure. Even though this code does not carry any monetary value, the aforementioned analysis shows that CMS uses submission rates to make important decisions. A low submission volume has led CMS to believe that these services are not being provided. That misconception can have a negative impact on the value of many procedures we perform. 

Dr. Lehrman operates Lehrman Consulting, LLC, is a consultant to the APMA Health Policy and Practice Department, serves as an expert panelist on Codingline, and is a Certified Professional Coder. Follow him on Twitter @DrLehrman.

References

1. American Medical Association.CPT 2019 (CPT/Current Procedural Terminlogy (Professional Edition)).American Medical Association; 2018.

2. Medicare Program; Revisions to Payment Policies under the Physician Fee Schedule and Other Revisions to Part B for CY 2019; Medicare Shared Savings Program Requirements; Quality Payment Program; and Medicaid Promoting Interoperability Program. https://www.federalregister.gov/documents/2018/11/23/2018-24170/medicare-program-revisions-to-payment-policies-under-the-physician-fee-schedule-and-other-revisions. Published November 23, 2018. Accessed June 17, 2019.