The new year promises to bring plenty of new changes to a host of coding and billing areas, though some are more obvious than others. For practices that perform procedures, the Centers for Medicare and Medicaid Services (CMS) are slowly investigating and making changes to 10-day global periods and 90-day global periods. According to a lesser-known section of the Medicare Access & CHIP Reauthorization Act (MACRA), CMS is actually required to “develop and implement a process to gather and analyze the necessary data on pre- and post-operative visits and other services furnished during global surgical periods other than the surgical procedure itself.”
In response, CMS spent much of 2017 collecting data regarding global periods. For the latter half of the year, CMS mandated that any practice containing ten or more physicians would have to report a specific CPT code along with any postoperative visit that occurred during the global period of a procedure. While this code did not affect payment in any way, it did allow CMS to see how many practices were actually following through with postoperative visits.
The results showed that 67% of procedures with 90-day global periods had a postop visit, while only 4% of procedures with 10-day global periods did the same. In order to narrow the margin of error caused by providers who performed postoperative visits but did not code them, CMS reviewed a smaller group with a history of consistent code reporting and determined that the percentages rose to 87% (90-day period) and 16% (10-day period).
While no official plans have been announced, many suspect that CMS’s findings will result in dramatically lowered or even discontinued reimbursement for postoperative visits after 10-day global periods, as the data shows that many physicians never even schedule these encounters. If you work for a practice that routinely performs these types of procedures, be sure to keep your eyes open for any payment changes that may come in the future.