CMS (Centers for Medicare and Medicaid, aka Medicare) has changed its post-operative visit reporting requirements for straight Medicare patients.  It is effective July 1, 2017.  At this time it is limited to a subset of providers.

 

Changes affect wide range of providers, but following are the pain management physicians impacted:

  • Pain management physicians
  • 10 or more provider practices
  • In states:
    • Florida
    • Kentucky
    • Louisiana
    • Nevada
    • New Jersey
    • North Dakota
    • Ohio
    • Oregon
    • Rhode Island

 

If your pain management practice meets all of these criteria, then you are now subject to these requirements.

 

The reporting requirement are part of the Medicare Access and CHIP Reauthoriza1on Act (MACRA), which gives CMS the opportunity to collect data on whether the post-operative visits that are included in the cost (RVU’s) of the global surgery codes are actually getting delivered.  If as a result of their data collection they determine that the number of post-op visits baked into their cost calculations is not actually being performed, CMS may alter the reimbursement for these procedures to take this into account.  CMS will also conduct surveys of surgery groups to obtain additional data on post-operative care.

 

Physicians and other impacted providers must report CPT 99024 (post-op E&M follow up visit including in global) for every post-op follow up visit that is related to the original global procedure.

 

A complete list of CPT codes affected is available from CMS.  Following are the CPT codes for pain management physicians:

 

CPT 22513 Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; thoracic
CPT 22514 Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; lumbar
CPT 62264 Percutaneous lysis of epidural adhesions using solution injection (e.g. hypertonic saline, enzyme) or mechanical means (e.g. catheter) including radiologic localization (includes contrasst when administered), multiple adhesiolysis sessions; 2 or more days
CPT 63650 Percutaneous lysis of epidural adhesions using solution injection (e.g. hypertonic saline, enzyme) or mechanical means (e.g. catheter) including radiologic localization (includes contrasst when administered), multiple adhesiolysis sessions; 1 day
CPT 63685 Insertion or replacement of spinal neurostimulator pulse generator or receivor, direct or inductive coupling
CPT 64555 Percutaneous implantation of neurostimulator electrode array; peripheral nerve
CPT 64561 Percutaneous implantation of neurostimulator electrode array; sacral nerve
CPT 64581 Incision for implantation of neurostimulator electrode array; sacral nerve
CPT 64612-64617 Chemodenervation of muscle(s)
CPT 63632 Destruction by neurolytic agent, plantar common digital nerve
CPT 64633; 64635 Destruction by neurolytic agent, paravertebral facet joint nerve(s) with imaging guidance: cervical/thoracic/lumbar/sacral
CPT 64640 Destruction by neurolytic agent; other peripheral nerve or branch

 

Source: AMA

 

 

About Apache Health

Apache Health is a revenue cycle management (RCM) analytics, benchmarking, and auditing company. The founders of Apache formerly ran a large RCM company that was acquired by a private equity group in a rollup. Apache’s predictive analytics will benchmark billing performance and project exactly how much more revenue you should earn from your existing volume of patients.  Using many factors and a blend of artificial intelligence and specialty specific benchmarks, the model projects whether changing the billing process would improve collections for your particular mix of procedures and payers. Apache Health can help you evaluate whether to outsource the billing, determine which billing company to select to maximize performance, or track in-house billing performance improvement over time. For more information contact:

Sean McSweeney

Apache Health

www.apachemedicalbilling.com

888-422-5514