Reporting global codes data in 2017

Starting July 1, the Centers for Medicare & Medicaid Services (CMS) will require practitioners in nine states who are part of groups of 10 or more to report data on the services that they provide for select 10- and 90-day global surgical codes. The data collected will be used to improve the accuracy of global codes starting in 2019.

CMS has set forth requirements for global codes data collection via claims, but the agency also has indicated that it will collect additional data using a survey and other methods such as data collection targeting Accountable Care Organizations (ACOs) and direct observation studies. At press time, details of the additional data collection had not been released. This column describes the information CMS has released regarding the claims-based global codes data collection.

Which providers are required to report global codes data?

The claims-based data collection requirements will apply to health care practitioners who are part of practices with 10 or more practitioners and located in one of nine specified states: Florida, Kentucky, Louisiana, Nevada, New Jersey, North Dakota, Ohio, Oregon, and Rhode Island. These states were selected because they offer a representative sample in terms of geography and Medicare beneficiary distribution.

What data must be reported and how?

Health care practitioners who meet claims-based data collection requirements will be required to report American Medical Association Current Procedure Terminology (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 every postoperative visit they provide within the global period of a select list of 10- or 90-day global codes. See Table 1 below for the list of codes.

CMS has determined that the 293 services on this list of global codes are provided to Medicare patients by more than 100 practitioners per year and are either furnished more than 10,000 times or have allowed charges of more than $10 million annually. The agency estimates that these 293 codes describe approximately 87 percent of all furnished 10- and 90-day global services, and approximately 77 percent of all Medicare expenditures for 10- and 90-day global services under the physician fee schedule.

Is claims-based data reporting mandatory? Is there a penalty for failure to report?

Yes, reporting is mandatory so that CMS can gather enough data on postoperative visits to improve the accuracy of global code values starting in 2019. CMS has the authority to implement a 5 percent withhold in payment for global services for health care professionals who fail to report; however, the agency has not implemented the withhold at this time. Although a penalty or withholding of payment for failure to report has not been implemented yet, the American College of Surgeons (ACS) urges all surgeons who are required to report to comply. Failure to report will result in incomplete data, which may affect the revaluation of global codes in 2019. Should data analysis of both inpatient and outpatient postsurgical visits not reflect existing global code definitions, new assumptions may be created to redefine postoperative care. In addition, failure to report data could result in the 5 percent withhold in payment for global services in future years.

What other forms of reporting on global codes could be required in 2017?

In addition to claims-based data collection, CMS plans to conduct a survey of practitioners to gain information on postoperative activities to supplement the claims-based data collection. CMS has not finalized the design of the survey, but intends to begin surveying mid-year. This survey could affect health care professionals in all states, not just the nine states selected for claims-based data reporting. CMS also has indicated that it plans to collect global code data from ACOs, but has not described how it plans to collect those data or when the ACO data collection will start.

Why is CMS requiring the reporting of global codes data?

For several years, CMS has communicated its concerns about the accuracy of the values assigned to 10- and 90-day global codes. In 2014, CMS proposed to transition all 10- and 90-day global codes to 0-day, with the requirement that postoperative visits would be reported separately. The ACS successfully argued against this transition because it would have resulted in a reduction in surgeons’ reimbursement for 10- and 90-day global services.

The Medicare Access and CHIP (Children’s Health Insurance Program) Reauthorization Act (MACRA) of 2015 prevented the transition of all 10- and 90-day global codes to 0-day global codes but required CMS to collect data, starting in 2017, to ensure the accuracy of the value for global codes starting in 2019. CMS then proposed that, starting January 1, all practitioners nationwide would be required to use G-codes to collect data from all 10- and 90-day global code claims. This policy would have been extremely burdensome for practitioners, and the likelihood of gathering accurate, usable data was low. As a result of aggressive ACS legislative and regulatory advocacy efforts, CMS announced in the 2017 Medicare Physician Fee Schedule final rule that the agency would not implement the G-code policy for all practitioners who report 10- and 90-day global codes. Instead, CMS indicated that it would require practitioners in groups of 10 or more who are located in nine selected states to report postoperative visit information on the list of specified codes. Refer to the ACS web page dedicated to this issue; more information will be posted as it becomes available.

I am a surgeon who is required to report—where can I get more information?

If you have questions regarding the reporting of global codes data, contact the ACS Division of Advocacy and Health Policy at regulatory@facs.org. For more information about global codes, visit the ACS website or the CMS website.

Table 1. CPT Codes for Required Global Surgical Reporting of 99024 for Postoperative Visits

CPT
code
Descripton Global period

10040

Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules)

010

10060

Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); simple or single

010

10061

Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); complicated or multiple

010

10120

Incision and removal of foreign body, subcutaneous tissues; simple

010

10140

Incision and drainage of hematoma, seroma or fluid collection

010

10160

Puncture aspiration of abscess, hematoma, bulla, or cyst

010

10180

Incision and drainage, complex, postoperative wound infection

010

11200

Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions

010

11400

Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 0.5 cm or less

010

11401

          excised diameter 0.6 to 1.0 cm

010

11402

          excised diameter 1.1 to 2.0 cm

010

11403

          excised diameter 2.1 to 3.0 cm

010

11404

          excised diameter 3.1 to 4.0 cm

010

11406

          excised diameter over 4.0 cm

010

11420

Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 0.5 cm or less

010

11421

          excised diameter 0.6 to 1.0 cm

010

11422

          excised diameter 1.1 to 2.0 cm

010

11423

          excised diameter 2.1 to 3.0 cm

010

11440

Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 0.5 cm or less

010

11441

          excised diameter 0.6 to 1.0 cm

010

11442

          excised diameter 1.1 to 2.0 cm

010

11443

          excised diameter 2.1 to 3.0 cm

010

11601

Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 0.6 to 1.0 cm

010

11602

          excised diameter 1.1 to 2.0 cm

010

11603

          excised diameter 2.1 to 3.0 cm

010

11604

          excised diameter 3.1 to 4.0 cm

010

11606

          excised diameter over 4.0 cm

010

11621

Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised diameter 0.6 to 1.0 cm

010

11622

          excised diameter 1.1 to 2.0 cm

010

11623

          excised diameter 2.1 to 3.0 cm

010

11640

Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 0.5 cm or less

010

11641

          excised diameter 0.6 to 1.0 cm

010

11642

          excised diameter 1.1 to 2.0 cm

010

11643

          excised diameter 2.1 to 3.0 cm

010

11644

          excised diameter 3.1 to 4.0 cm

010

11646

          excised diameter over 4.0 cm

010

11750

Excision of nail and nail matrix, partial or complete (eg, ingrown or deformed nail), for permanent removal

010

11765

Wedge excision of skin of nail fold (eg, for ingrown toenail)

010

12031

Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 2.5 cm or less

010

12032

          2.6 cm to 7.5 cm

010

12034

          7.6 cm to 12.5 cm

010

12041

Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 2.5 cm or less

010

12042

          2.6 cm to 7.5 cm

010

12051

Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less

010

12052

          2.6 cm to 5.0 cm

010

13101

Repair, complex, trunk; 2.6 cm to 7.5 cm

010

13121

Repair, complex, scalp, arms, and/or legs; 2.6 cm to 7.5 cm

010

13131

Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; 1.1 cm to 2.5 cm

010

13132

          2.6 cm to 7.5 cm

010

13151

Repair, complex, eyelids, nose, ears and/or lips; 1.1 cm to 2.5 cm

010

13152

          2.6 cm to 7.5 cm

010

13160

Secondary closure of surgical wound or dehiscence, extensive or complicated

090

14020

Adjacent tissue transfer or rearrangement, scalp, arms and/or legs; defect 10 sq cm or less

090

14021

          defect 10.1 sq cm to 30.0 sq cm

090

14040

Adjacent tissue transfer or rearrangement, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; defect 10 sq cm or less

090

14041

          defect 10.1 sq cm to 30.0 sq cm

090

14060

Adjacent tissue transfer or rearrangement, eyelids, nose, ears and/or lips; defect 10 sq cm or less

090

14061

          defect 10.1 sq cm to 30.0 sq cm

090

14301

          defect 30.1 sq cm to 60.0 sq cm

090

15100

Split-thickness autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children (except 15050)

090

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)

090

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

090

15260

Full thickness graft, free, including direct closure of donor site, nose, ears, eyelids, and/or lips; 20 sq cm or less

090

15732

Muscle, myocutaneous, or fasciocutaneous flap; head and neck (eg, temporalis, masseter muscle, sternocleidomastoid, levator scapulae)

090

15734

          trunk

090

15823

Blepharoplasty, upper eyelid; with excessive skin weighting down lid

090

17000

Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion

010

17004

          15 or more lesions

010

17110

Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions

010

17111

          15 or more lesions

010

17260

Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less

010

17261

          lesion diameter 0.6 to 1.0 cm

010

17262

          lesion diameter 1.1 to 2.0 cm

010

17263

Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm

010

17270

Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less

010

17271

          lesion diameter 0.6 to 1.0 cm

010

17272

          lesion diameter 1.1 to 2.0 cm

010

17273

          lesion diameter 2.1 to 3.0 cm

010

17280

Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less

010

17281

          lesion diameter 0.6 to 1.0 cm

010

17282

          lesion diameter 1.1 to 2.0 cm

010

17283

          lesion diameter 2.1 to 3.0 cm

010

19120

Excision of cyst, fibroadenoma, or other benign or malignant tumor, aberrant breast tissue, duct lesion, nipple or areolar lesion (except 19300), open, male or female, 1 or more lesions

090

19125

Excision of breast lesion identified by preoperative placement of radiological marker, open; single lesion

090

19301

Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy)

090

19303

Mastectomy, simple, complete

090

19307

Mastectomy, modified radical, including axillary lymph nodes, with or without pectoralis minor muscle, but excluding pectoralis major muscle

090

19357

Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion

090

20670

Removal of implant; superficial (eg, buried wire, pin or rod) (separate procedure)

010

20680

Removal of implant; deep (eg, buried wire, pin, screw, metal band, nail, rod or plate)

090

20926

Tissue grafts, other (eg, paratenon, fat, dermis)

090

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

010

22514

          lumbar

010

22551

Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots; cervical below C2

090

22558

Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); lumbar

090

22600

Arthrodesis, posterior or posterolateral technique, single level; cervical below C2 segment

090

22612

          lumbar (with lateral transverse technique, when performed)

090

22630

Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace (other than for decompression), single interspace; lumbar

090

22633

Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace and segment; lumbar

090

22830

Exploration of spinal fusion

090

23120

Claviculectomy; partial

090

23412

Repair of ruptured musculotendinous cuff (eg, rotator cuff) open; chronic

090

23430

Tenodesis of long tendon of biceps

090

23472

Arthroplasty, glenohumeral joint; total shoulder (glenoid and proximal humeral replacement [eg, total shoulder])

090

23500

Closed treatment of clavicular fracture; without manipulation

090

23600

Closed treatment of proximal humeral (surgical or anatomical neck) fracture; without manipulation

090

23615

Open treatment of proximal humeral (surgical or anatomical neck) fracture, includes internal fixation, when performed, includes repair of tuberosity(s), when performed

090

23650

Closed treatment of shoulder dislocation, with manipulation; without anesthesia

090

25447

Arthroplasty, interposition, intercarpal or carpometacarpal joints

090

25600

Closed treatment of distal radial fracture (eg, Colles or Smith type) or epiphyseal separation, includes closed treatment of fracture of ulnar styloid, when performed; without manipulation

090

25605

          with manipulation

090

25607

Open treatment of distal radial extra-articular fracture or epiphyseal separation, with internal fixation

090

25609

Open treatment of distal radial intra-articular fracture or epiphyseal separation; with internal fixation of 3 or more fragments

090

26055

Tendon sheath incision (eg, for trigger finger)

090

26160

Excision of lesion of tendon sheath or joint capsule (eg, cyst, mucous cyst, or ganglion), hand or finger

090

26600

Closed treatment of metacarpal fracture, single; without manipulation, each bone

090

26720

Closed treatment of phalangeal shaft fracture, proximal or middle phalanx, finger or thumb; without manipulation, each

090

27125

Hemiarthroplasty, hip, partial (eg, femoral stem prosthesis, bipolar arthroplasty)

090

27130

Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip arthroplasty), with or without autograft or allograft

090

27132

Conversion of previous hip surgery to total hip arthroplasty, with or without autograft or allograft

090

27134

Revision of total hip arthroplasty; both components, with or without autograft or allograft

090

27235

Percutaneous skeletal fixation of femoral fracture, proximal end, neck

090

27236

Open treatment of femoral fracture, proximal end, neck, internal fixation or prosthetic replacement

090

27244

Treatment of intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture; with plate/screw type implant, with or without cerclage

090

27245

          with intramedullary implant, with or without interlocking screws and/or cerclage

090

27446

Arthroplasty, knee, condyle and plateau; medial OR lateral compartment

090

27447

          medial AND lateral compartments with or without patella resurfacing (total knee arthroplasty)

090

27486

Revision of total knee arthroplasty, with or without allograft; 1 component

090

27487

          femoral and entire tibial component

090

27506

Open treatment of femoral shaft fracture, with or without external fixation, with insertion of intramedullary implant, with or without cerclage and/or locking screws

090

27590

Amputation, thigh, through femur, any level

090

27786

Closed treatment of distal fibular fracture (lateral malleolus); without manipulation

090

27814

Open treatment of bimalleolar ankle fracture (eg, lateral and medial malleoli, or lateral and posterior malleoli, or medial and posterior malleoli), includes internal fixation, when performed

090

27880

Amputation, leg, through tibia and fibula

090

28122

Partial excision (craterization, saucerization, sequestrectomy, or diaphysectomy) bone (eg, osteomyelitis or bossing); tarsal or metatarsal bone, except talus or calcaneus

090

28124

          phalanx of toe

090

28232

Tenotomy, open, tendon flexor; toe, single tendon (separate procedure)

090

28270

Capsulotomy; metatarsophalangeal joint, with or without tenorrhaphy, each joint (separate procedure)

090

28285

Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy)

090

28296

Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with distal metatarsal osteotomy, any method

090

28308

Osteotomy, with or without lengthening, shortening or angular correction, metatarsal; other than first metatarsal, each

090

28470

Closed treatment of metatarsal fracture; without manipulation, each

090

28510

Closed treatment of fracture, phalanx or phalanges, other than great toe; without manipulation, each

090

28810

Amputation, metatarsal, with toe, single

090

28820

Amputation, toe; metatarsophalangeal joint

090

28825

          interphalangeal joint

090

29822

Arthroscopy, shoulder, surgical; debridement, limited

090

29823

          debridement, extensive

090

29824

          distal claviculectomy including distal articular surface (Mumford procedure)

090

29827

          with rotator cuff repair

090

29828

          biceps tenodesis

090

29848

Endoscopy, wrist, surgical, with release of transverse carpal ligament

090

29876

Arthroscopy, knee, surgical; synovectomy, major, 2 or more compartments (eg, medial or lateral)

090

29879

          abrasion arthroplasty (includes chondroplasty where necessary) or multiple drilling or microfracture

090

29880

          with meniscectomy (medial AND lateral, including any meniscal shaving) including debridement/shaving of articular cartilage (chondroplasty), same or separate compartment(s), when performed

090

29881

          with meniscectomy (medial OR lateral, including any meniscal shaving) including debridement/shaving of articular cartilage (chondroplasty), same or separate compartment(s), when performed

090

30140

Submucous resection inferior turbinate, partial or complete, any method

090

30520

Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft

090

32480

Removal of lung, other than pneumonectomy; single lobe (lobectomy)

090

32663

Thoracoscopy, surgical; with lobectomy (single lobe)

090

33207

Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); ventricular

090

33208

          atrial and ventricular

090

33228

Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; dual lead system

090

33249

Insertion or replacement of permanent implantable defibrillator system, with transvenous lead(s), single or dual chamber

090

33263

Removal of implantable defibrillator pulse generator with replacement of implantable defibrillator pulse generator; dual lead system

090

33264

          multiple lead system

090

33282

Implantation of patient-activated cardiac event recorder

090

33405

Replacement, aortic valve, open, with cardiopulmonary bypass; with prosthetic valve other than homograft or stentless valve

090

33426

Valvuloplasty, mitral valve, with cardiopulmonary bypass; with prosthetic ring

090

33430

Replacement, mitral valve, with cardiopulmonary bypass

090

33533

Coronary artery bypass, using arterial graft(s); single arterial graft

090

33860

Ascending aorta graft, with cardiopulmonary bypass, includes valve suspension, when performed

090

34802

Endovascular repair of infrarenal abdominal aortic aneurysm or dissection; using modular bifurcated prosthesis (1 docking limb)

090

34825

Placement of proximal or distal extension prosthesis for endovascular repair of infrarenal abdominal aortic or iliac aneurysm, false aneurysm, or dissection; initial vessel

090

35301

Thromboendarterectomy, including patch graft, if performed; carotid, vertebral, subclavian, by neck incision

090

36470

Injection of sclerosing solution; single vein

010

36471

          multiple veins, same leg

010

36558

Insertion of tunneled centrally inserted central venous catheter, without subcutaneous port or pump; age 5 years or older

010

36561

Insertion of tunneled centrally inserted central venous access device, with subcutaneous port; age 5 years or older

010

36581

Replacement, complete, of a tunneled centrally inserted central venous catheter, without subcutaneous port or pump, through same venous access

010

36589

Removal of tunneled central venous catheter, without subcutaneous port or pump

010

36590

Removal of tunneled central venous access device, with subcutaneous port or pump, central or peripheral insertion

010

36819

Arteriovenous anastomosis, open; by upper arm basilic vein transposition

090

36821

          direct, any site (eg, Cimino type) (separate procedure)

090

36830

Creation of arteriovenous fistula by other than direct arteriovenous anastomosis (separate procedure); nonautogenous graft (eg, biological collagen, thermoplastic graft)

090

36832

Revision, open, arteriovenous fistula; without thrombectomy, autogenous or nonautogenous dialysis graft (separate procedure)

090

37607

Ligation or banding of angioaccess arteriovenous fistula

090

37609

Ligation or biopsy, temporal artery

010

37765

Stab phlebectomy of varicose veins, 1 extremity; 10-20 stab incisions

090

37766

          more than 20 incisions

090

38500

Biopsy or excision of lymph node(s); open, superficial

010

38525

          open, deep axillary node(s)

090

38571

Laparoscopy, surgical; with bilateral total pelvic lymphadenectomy

010

38724

Cervical lymphadenectomy (modified radical neck dissection)

090

40808

Biopsy, vestibule of mouth

010

43281

Laparoscopy, surgical, repair of paraesophageal hernia, includes fundoplasty, when performed; without implantation of mesh

090

43644

Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and Roux-en-Y gastroenterostomy (roux limb 150 cm or less)

090

44005

Enterolysis (freeing of intestinal adhesion) (separate procedure)

090

44120

Enterectomy, resection of small intestine; single resection and anastomosis

090

44140

Colectomy, partial; with anastomosis

090

44143

          with end colostomy and closure of distal segment (Hartmann type procedure)

090

44145

          with coloproctostomy (low pelvic anastomosis)

090

44160

          with removal of terminal ileum with ileocolostomy

090

44204

Laparoscopy, surgical; colectomy, partial, with anastomosis

090

44205

          colectomy, partial, with removal of terminal ileum with ileocolostomy

090

44207

          colectomy, partial, with anastomosis, with coloproctostomy (low pelvic anastomosis)

090

44970

Laparoscopy, surgical, appendectomy

090

46221

Hemorrhoidectomy, internal, by rubber band ligation(s)

010

46500

Injection of sclerosing solution, hemorrhoids

010

46930

Destruction of internal hemorrhoid(s) by thermal energy (eg, infrared coagulation, cautery, radiofrequency)

090

47562

Laparoscopy, surgical; cholecystectomy

090

47563

          cholecystectomy with cholangiography

090

47600

Cholecystectomy

090

49422

Removal of tunneled intraperitoneal catheter

010

49440

Insertion of gastrostomy tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report

010

49505

Repair initial inguinal hernia, age 5 years or older; reducible

090

49507

          incarcerated or strangulated

090

49560

Repair initial incisional or ventral hernia; reducible

090

49561

          incarcerated or strangulated

090

49585

Repair umbilical hernia, age 5 years or older; reducible

090

49650

Laparoscopy, surgical; repair initial inguinal hernia

090

50360

Renal allotransplantation, implantation of graft; without recipient nephrectomy

090

50590

Lithotripsy, extracorporeal shock wave

090

52601

Transurethral electrosurgical resection of prostate, including control of postoperative bleeding, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy are included)

090

52648

Laser vaporization of prostate, including control of postoperative bleeding, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, internal urethrotomy and transurethral resection of prostate are included if performed)

090

53850

Transurethral destruction of prostate tissue; by microwave thermotherapy

090

54161

Circumcision, surgical excision other than clamp, device, or dorsal slit; older than 28 days of age

010

55866

Laparoscopy, surgical prostatectomy, retropubic radical, including nerve sparing, includes robotic assistance, when performed

090

57240

Anterior colporrhaphy, repair of cystocele with or without repair of urethrocele

090

57288

Sling operation for stress incontinence (eg, fascia or synthetic)

090

58571

Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less;
with removal of tube(s) and/or ovary(s)

090

58661

          with removal of adnexal structures (partial or total oophorectomy and/or salpingectomy)

010

60240

Thyroidectomy, total or complete

090

60500

Parathyroidectomy or exploration of parathyroid(s)

090

61312

Craniectomy or craniotomy for evacuation of hematoma, supratentorial; extradural or subdural

090

61510

Craniectomy, trephination, bone flap craniotomy;
for excision of brain tumor, supratentorial, except meningioma

090

62264

Percutaneous lysis of epidural adhesions using solution injection (eg, hypertonic saline, enzyme) or mechanical means (eg, catheter) including radiologic localization (includes contrast when administered), multiple adhesiolysis sessions; 1 day

010

63030

Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; 1 interspace, lumbar

090

63042

Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, reexploration, single interspace; lumbar

090

63045

Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; cervical

090

63047

          lumbar

090

63056

Transpedicular approach with decompression of spinal cord, equina and/or nerve root(s) (eg, herniated intervertebral disc), single segment; lumbar (including transfacet, or lateral extraforaminal approach) (eg, far lateral herniated intervertebral disc)

090

63081

Vertebral corpectomy (vertebral body resection), partial or complete, anterior approach with decompression of spinal cord and/or nerve root(s); cervical, single segment

090

63650

Percutaneous implantation of neurostimulator electrode array, epidural

010

63685

Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling

010

64555

Percutaneous implantation of neurostimulator electrode array; peripheral nerve (excludes sacral nerve)

010

64561

Percutaneous implantation of neurostimulator electrode array; sacral nerve (transforaminal placement) including image guidance, if performed

010

64581

Incision for implantation of neurostimulator electrode array; sacral nerve (transforaminal placement)

090

64590

Insertion or replacement of peripheral or gastric neurostimulator pulse generator or receiver, direct or inductive coupling

010

64612

Chemodenervation of muscle(s); muscle(s) innervated by facial nerve, unilateral (eg, for blepharospasm, hemifacial spasm)

010

64615

Chemodenervation of muscle(s); muscle(s) innervated by facial, trigeminal, cervical spinal and accessory nerves, bilateral (eg, for chronic migraine)

010

64616

Chemodenervation of muscle(s); neck muscle(s), excluding muscles of the larynx, unilateral (eg, for cervical dystonia, spasmodic torticollis)

010

64617

Chemodenervation of muscle(s); larynx, unilateral, percutaneous (eg, for spasmodic dysphonia), includes guidance by needle electromyography, when performed

010

64632

Destruction by neurolytic agent; plantar common digital nerve

010

64633

Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); cervical or thoracic, single facet joint

010

64635

          lumbar or sacral, single facet joint

010

64640

Destruction by neurolytic agent; other peripheral nerve or branch

010

64718

Neuroplasty and/or transposition; ulnar nerve at elbow

090

64721

          median nerve at carpal tunnel

090

65756

Keratoplasty (corneal transplant); endothelial

090

65855

Trabeculoplasty by laser surgery

010

66170

Fistulization of sclera for glaucoma; trabeculectomy ab externo in absence of previous surgery

090

66179

Aqueous shunt to extraocular equatorial plate reservoir, external approach; without graft

090

66180

          with graft

090

66711

Ciliary body destruction; cyclophotocoagulation, endoscopic

090

66761

Iridotomy/iridectomy by laser surgery (eg, for glaucoma) (per session)

010

66821

Discission of secondary membranous cataract (opacified posterior lens capsule and/or anterior hyaloid); laser surgery (eg, YAG laser) (1 or more stages)

090

66982

Extracapsular cataract removal with insertion of intraocular lens prosthesis (1-stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification), complex, requiring devices or techniques not generally used in routine cataract surgery (eg, iris expansion device, suture support for intraocular lens, or primary posterior capsulorrhexis) or performed on patients in the amblyogenic developmental stage

090

66984

Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification)

090

67036

Vitrectomy, mechanical, pars plana approach

090

67040

          with endolaser panretinal photocoagulation

090

67041

          with removal of preretinal cellular membrane (eg, macular pucker)

090

67042

          with removal of internal limiting membrane of retina (eg, for repair of macular hole, diabetic macular edema), includes, if performed, intraocular tamponade (ie, air, gas or silicone oil)

090

67108

Repair of retinal detachment; with vitrectomy, any method, including, when performed, air or gas tamponade, focal endolaser photocoagulation, cryotherapy, drainage of subretinal fluid, scleral buckling, and/or removal of lens by same technique

090

67113

Repair of complex retinal detachment (eg, proliferative vitreoretinopathy, stage C-1 or greater, diabetic traction retinal detachment, retinopathy of prematurity, retinal tear of greater than 90 degrees), with vitrectomy and membrane peeling, including, when performed, air, gas, or silicone oil tamponade, cryotherapy, endolaser photocoagulation, drainage of subretinal fluid, scleral buckling, and/or removal of lens

090

67145

Prophylaxis of retinal detachment (eg, retinal break, lattice degeneration) without drainage, 1 or more sessions; photocoagulation (laser or xenon arc)

090

67210

Destruction of localized lesion of retina (eg, macular edema, tumors), 1 or more sessions; photocoagulation

090

67228

Treatment of extensive or progressive retinopathy (eg, diabetic retinopathy), photocoagulation

010

67255

Scleral reinforcement (separate procedure); with graft

090

67800

Excision of chalazion; single

010

67840

Excision of lesion of eyelid (except chalazion) without closure or with simple direct closure

010

67900

Repair of brow ptosis (supraciliary, mid-forehead or coronal approach)

090

67904

Repair of blepharoptosis; (tarso) levator resection or advancement, external approach

090

67917

Repair of ectropion; extensive (eg, tarsal strip operations)

090

67924

          extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation)

090

68760

Closure of the lacrimal punctum; by thermocauterization, ligation, or laser surgery

010

68761

          by plug, each

010

68801

Dilation of lacrimal punctum, with or without irrigation

010

68810

Probing of nasolacrimal duct, with or without irrigation

010

68840

Probing of lacrimal canaliculi, with or without irrigation

010

69420

Myringotomy including aspiration and/or eustachian tube inflation

010

69433

Tympanostomy (requiring insertion of ventilating tube), local or topical anesthesia

010

69436

          general anesthesia

010


*All specific references to CPT codes and descriptions are © 2016 American Medical Association. All rights reserved. CPT and CodeManager are registered trademarks of the American Medical Association.

Foe L, Nagle J, Ollapally V. The 2017 Medicare physician fee schedule: An overview of provisions that will affect surgical practice. Bull Am Coll Surg. 2017;102(1):11-15. Available at: bulletin.facs.org/2017/01/the-2017-medicare-physician-fee-schedule-an-overview-of-provisions-that-will-affect-surgical-practice/. Accessed February 23, 2017.

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