The current procedural terminology (CPT) describes the postoperative follow-up visit.
It usually comprises the surgical package to designate that the provider did perform an evaluation and management service during a postoperative period for reasons related to the original procedure.
The provider performs an E/M examination during the global surgical period for surgery; the patient already had gone through it before.
The global surgical package, also referred to as global surgery, includes all the compulsory services generally supplied by a surgeon before, during, and after a procedure.
Medicare payment for a surgical procedure consists of the preoperative and intra-operative.
The provider typically performs the postoperative services or associates of the same group with the same specialty.
99024 CPT Code Description
Firstly, what is meant by an E/M visit? E/M stands for evaluation and management, and it refers to the engagement of physicians with patients.
These physician-patient encounters are translated into five digits CPT codes.
Evaluation and management are encounters between the patient and the health care provider.
The provider evaluates the patient’s health conditions and suggests a plan of action according to the patient’s medical condition.
There are mainly three critical evaluation and management visits components: history, examination, and medical decision-making.
Medical decision-making is an essential component in all of them.
Depending on the procedure, there may be a follow-up period during which follow-up care is included in the payment for the process and not separately payable.
The insurance may consider it a bundled care into the global surgery package.
All other insurances follow the global periods adopted by the Centers for Medicare & Medicaid Services (CMS).
Reimbursement (of surgery) includes a box for all related services and routine and necessary supplies for the procedure.
A global surgery service is permissible to complete in any setting, including hospitals, doctor’s offices, or an ambulatory surgery center.
Postoperative services include dressing changes or incision care, post-op pain management, removal of sutures, and others.
Supplies required for and related to the surgery are mandatory in the surgical package.
Services that do not enclose in a global surgical box include consultations, other doctor’s services, and treatment for underlying conditions.
These diagnostic tests are outside of the surgical procedure.
There are a few sorts of packages (global surgical packages) based on the number of postoperative days.
0 – Day global period means there is no preoperative period. And there are no postoperative days. Visit on the procedure day is generally not payable as a separate service.
10 – Day is the postoperative period for minor procedures. The visit on the procedure day is generally not payable as a separate service.
The period (total global period) is 11 days from the day of the surgery. And the period (total global period) is ten days immediately following the day of the surgery.
90 – Days global period shows there are 90 postoperative days (major procedure).
But it has a one–day preoperative period. The day of the technique is generally not payable as a separate service.
The total global period is 92 days which means one day before the operation, the day of operation, and the 90 days immediately following the day of operation.
Medicare encloses the following services in the global surgery payment when provided in addition to the surgery.
Preoperative visits are visits after which the provider decides for operation.
It includes preoperative visits for more extensive procedures on the day before the surgery date. For minor procedures, this includes preoperative visits on the day of surgery.
Intra-operative services are usually a regular and necessary part of a surgical procedure.
During the postoperative course of the operation, the follow-up visits are relevant to recovery from the surgery: post-surgical pain management and supplies used during the process.
The following services are not a part of the global surgical package. One may bill these services separately to get paid.
Assessment of the problem by the provider is to decide the need for major surgeries.
Using modifier 57 (Decision for Surgery), one may bill this service separately.
This visit may be billed independently only for major surgical procedures.
The global surgery package comprises continually assessing minor surgical techniques and endoscopy.
The worldwide payment constitutes specific visits by the exact physician on the same day as minor surgery or endoscopy unless a significant, separately identifiable service is already there to perform.
Use modifier 25 if the same provider executes the procedure on the same DOS for billing and individually recognizable E/M (evaluation and management) service by the same physician on the same day of the method.
The postoperative follow-up, CPT code 99024, is compulsory for all visits provided during the global period.
And it is regardless of the postoperative care setting.
The CPT 99024 has the cost of a claim with no reimbursement.
The postoperative follow-up visit code 99024 is used as a space holder.
The CMS is involved to see if the required visits for evaluation in global periods are eligible.
It is chiefly important as CMS legally works under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
Authorities have disbursed several billions of dollars for encounters comprising the package (global package).
And this code is one way the government may track them. Concerning staff is well aware not to forget the CPT 99024 while billing postoperative follow-up visits.
While submitting the claim, make sure that it includes all the proper services to Medicare.
It involves careful checking of the global fee periods.
Understanding and using the codes correctly will help reduce incorrect billing, denials, or interruptions in the patient’s medical services.
99024 CPT Code Billing Guidelines
While submitting the postoperative follow-up visit, first understand the usage of 99024 CPT Code.
It is a Medicare bundled code with zero relative value units (RVUs). And it has no fee on the Medicare Physician Fee Schedule (MPFS); CMS is interested in collecting this information.
Medicare may reimburse bundled code, but not when the provider has performed the service.
Because government insurance pays for the service in advance, it is suitably interested in whether the provider performs it.
Thorough postoperative care minimizes the risk of surgery problems, including pain, helps manage the side effects of the procedure, and supports recovery.
There are some general guidelines for postoperative period billing.
The same provider executes a distinct procedure or evaluation and management service during a postoperative period.
The coder or biller may use two modifiers to simplify billing for visits and other methods in the postoperative period of a surgical procedure but not included in the payment for the surgical procedure.
Modifier 79 narrates the process (unrelated) or service by the same physician during a postoperative time.
The health professional may need to indicate that a function or service furnished during a postoperative period was unrelated to the original procedure.
A new postoperative period begins when someone bills the irrelevant method. Modifier 24 is represented as (unrelated evaluation and management service by the same physician during a postoperative period).
The physician may need to indicate that he provides the assessment and management service during an unrelated procedure’s postoperative period.
An E/M service billed with modifier 24 medical notes must support that the service is irrelevant to the postoperative care of the technique.
The CPT 99024, when performing an evaluation and management service during a global period, is related to the procedure for which the patient is in the worldwide period.
It applies to services with both 10 – day and 90 – day global periods.
Some have viewed the reporting of this code as optional because it is not associated with any payment.
It is essential to know those who practice (in Florida, Kentucky, Louisiana, Nevada, New Jersey, North Dakota, Ohio, Oregon, and Rhode Island).
When it is an appropriate time, the Centers for Medicare and Medicaid Services (CMS) require CPT 99024 in those states.
While submitting the postoperative follow-up visit (CPT 99024), one must report these visits through the normal process for filing a claim.
The coder or biller should submit provider, patient, and date-of-service information for claim submission.
The postoperative visit (CPT 99024) does not need to link the related 10 – day or 90 – day global code, and it is not essential to add any modifiers.
The provider should follow standard Medicare billing requirements to determine that he provided the visits and correctly used the code.
It is significant to note that the Centers for Medicare & Medicaid Services (CMS) may use the collected data to revalue surgery CPT codes.
Therefore, providing complete and precise information about postoperative visits is of critical importance.
Correct usage of postoperative follow-up CPT 99024 is also applied in teaching hospitals and to services provided by residents.
Moreover, the provider must be present during postoperative follow-up visits in the primary or critical portions of the service.
The reporting requirement dictates the usage of 99024 CPT code for all postoperative visits in the global package, not just office visits.
CMS states it in its Global Surgery Data Collection Requirement. It is mandatory to report 99024 CPT code for all postoperative follow-up visits.
But it must be during the global period, regardless of the postoperative care setting.
The CPT code 99024 for postoperative care will help ensure surgeons are reimbursed sufficiently for all their work.
And help postoperative physician visits achieve better health results for patients.
The CMS provides the guidelines for telemedicine during the COVID – 19 national public health emergency (PHE).
CMS considers procedure codes 99024 eligible to be performed as telemedicine from March 13, 2020, until the PHE expires.
New York does not separately reimburse for CPT 99024 during or after the PHE.
Due to COVID 19 Pandemic, CMS temporarily added the postoperative follow-up visit codes to the policy.
This addition took place with a start date of Feb – 2020 for the duration till the government lifts national public health emergency.
The professional billing is to claim non-traditional telehealth services for the Public Health Emergency (PHE) duration.
Then bill with the Place of Service (POS) equal to what it would have been without a PHE.
Also, bill it along with a modifier 95 for Medicare, indicating that the provider accomplished the service via telehealth.
As a reminder, CMS does not require the “CR” modifier on telehealth services.
During public health emergency, postoperative follow-up visits (CPT 99024) with modifier GT is necessary to represent the service performed via telehealth.
Append GT modifier with CPT 99024 to bill for commercial insurances.
The following are examples of when 99024 CPT code can be used.
A 44 – year old patient was seen in the provider’s office five days ago with a 2.5 – cm laceration to the right anterior side of the wrist.
An intermediate layered closure was performed (CPT code 12031).
The same patient now presents with redness, swelling, and drainage to the sutured area. The final diagnosis was infected laceration.
The coder correctly gives the following CPT code in this case 99024 CPT code Postoperative Follow-Up Visit, Included Surgical Package, E&M Performed.
The modifier is not acceptable because all services go under the code assigned.
In the second example, a 56 – year old male patient was seen in the provider’s office 30 days ago for permanent sterilization or contraception (55250).
The same patient again visits the provider’s office to confirm the complete sterilization in semen test. There is no reason for the visit to sterilize (ICD – 10 CM code Z30.2).
After reviewing the previous surgical data and current medical notes, for example, the coder suggests CPT code 99024 as a postoperative follow-up visit and diagnosis code Z30.2.