Global Surgery Package – Our Future?

CMS (Centers for Medicare and Medicaid Services) has been collecting data on post-operative care visits for years. They are trying to evaluate the appropriateness of the current surgical global payment structure, specifically post-op care. They have broken it down by performing provider, setting, and intensity of care.

“Medicare required select practitioners from nine states (Florida, Kentucky, Louisiana, Nevada, New Jersey, North Dakota, Ohio, Oregon, and Rhode Island) to report on their post-operative visits (using CPT code 99024) following high volume or high-cost procedures beginning July 1, 2017.”

Presently, we capture post-op care visits with CPT code 99024. However, for the purpose of this data collection project, CMS proposed several G-codes to capture various levels of care provided by the care team. These G-codes are not approved for use just yet, but I wonder how much longer before we see an overhaul here, like we did with E/M (Evaluation and Management) codes.

According to the RAND 2021 Report, “Medicare payment for many surgical procedures covers not only the procedure itself, but also post-op care provided by the same practitioner over a fixed period of time (the “global period”). What the data revealed was that fewer post-op visits were performed than what was expected when CMS set the global payment rate. Also consider, today’s healthcare environment is now structured around a team-based approach. So, it is quite possible that the practitioner who performed the procedure, is not who is performing the post-op care.

The report data showed that procedures with a 10 or 90-day global associated are over-valued. The data found that only 4% of procedures with a 10-day global reported a post-op visit. And, although 70% of procedures having a 90-day global, only 38% reported the expected amount of post-op visits.

2025 Update:  CMS creates G0559 effective January 1, 2025

Global surgery – New (add-on) HCPCS code G0559

Effective for dates of services on and after January 1, 2025, providers begin to bill using HCPCS code G0559. This code must be reported separately in addition to an office or outpatient E/M service. G0559 may only be reported once during the 90-day global period. For complete details on this new code, please review the global surgery booklet.

Final Thoughts

I encourage you to take a look at how they are proposing a “possible” future of post-op care reporting. It’s not here yet, but they aren’t collecting and studying data for no reason. It is on the horizon.

 

Stay tuned to see how this nail-biter turns out.

Resources:

CMS – Global Surgery Data Collection

CMS – Report on G-Code Testing