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:
- New Jersey
- North Dakota
- 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|
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