Global Surgery Data Collection and Reporting for Postoperative Care
In 2017, the Centers for Medicare and Medicaid Services (CMS) finalized a policy, required by the Medicare Access and CHIP Reauthorization Act (MACRA), in which some physicians that provide 10- and 90-day global services would be required to report information on the number of postoperative visits they provide.
Who is required to report postoperative care information?
Practitioners in 9 states, Florida, Kentucky, Louisiana, Nevada, New Jersey, North Dakota, Ohio, Oregon and Rhode Island, are required to report data on every postoperative visits furnished during the global period of specified procedures.
While this policy only affects practitioners in the above listed states who belong to groups of 10 practitioners or more. ASPS encourages all surgeons to report each postoperative visit to CMS.
What will need to be reported? And how will it be reported?
Practitioners who meet requirements and perform any of the surgical CPT codes that have been identified will report postoperative visits using CPT code 99024, (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) for each postoperative evaluation and management visit they provide within the global period. This includes every facility visit (inpatient, outpatient, observation) as well as office visits.
The specified procedures have been identified as those that are furnished by more than 100 practitioners and are either nationally furnished more than 10,000 times annually or have more than $10 million in annual allowed charges. Please see below for a complete list of procedures that must follow the new guidelines.
Why is it important to participate?
This is a mandatory policy for some surgeons. Currently there is no penalty for not participating, however, there is the possibility of future payments being withheld if data is not routinely shared. It is important to report because incomplete reporting means incomplete and inaccurate data and can result in reduced global codes and values.
How will Plastic Surgeons be affected?
Plastic Surgeons who bill the following codes may be impacted:
| CPT Code | Description |
|---|---|
| 11406 | Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter over 4.0 cm |
| 11423 | Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 2.1 to 3.0 cm |
| 11442 | Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 1.1 to 2.0 cm |
| 11443 | Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 2.1 to 3.0 cm |
| 11643 | Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 2.1 to 3.0 cm |
| 11644 | Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 3.1 to 4.0 cm |
| 13160 | Secondary closure of surgical wound or dehiscence, extensive or complicated |
| 14020 | Adjacent tissue transfer or rearrangement, scalp, arms and/or legs; defect 10 sq cm or less |
| 14021 | Adjacent tissue transfer or rearrangement, scalp, arms and/or legs; defect 10.1 sq cm to 30.0 sq cm |
| 14040 | Adjacent tissue transfer or rearrangement, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; defect 10 sq cm or less |
| 14060 | Adjacent tissue transfer or rearrangement, eyelids, nose, ears and/or lips; defect 10 sq cm or less |
| 14301 | Adjacent tissue transfer or rearrangement, any area; defect 30.1 sq cm to 60.0 sq cm |
| 15100 | Split-thickness autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children (except 15050) |
| 15120 | Split-thickness autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet and/or multiple digits; first 100 sq cm or less, or 1% of body area of infants and children (except 15050) |
| 15240 | Full thickness graft, free, including direct closure of donor site, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; 20 sq cm or less |
| 15732 | Muscle, myocutaneous, or fasciocutaneous flap; head and neck (eg, temporalis, masseter muscle, sternocleidomastoid, levator scapulae) |
| 15734 | Muscle, myocutaneous, or fasciocutaneous flap; trunk |
| 15769 | NEW:Grafting of autologous soft tissue, other, harvested by direct excision (eg, fat, dermis, fascia) |
| 15771 | NEW: Grafting of autologous fat harvested by liposuction technique to trunk, breasts, scalp, arms and/or legs; 50 cc or less injectate |
| 15773 | NEW: Grafting of autologous fat harvested by liposuction technique to face, eyelids, mouth, neck, ears, orbits, genitalia, hands and/or feet; 25 cc or less injectate |
| 19357 | Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion |
*For a complete list of all surgical CPT codes that require reporting of postoperative visits, please click here.
Resources
- Centers for Medicare & Medicaid Services: www.cms.gov
- Contact CMS: MACRA_Global_Surgery@cms.hhs.gov
- Contact ASPS: (847) 228-9900 or eadler@plasticsurgery.org