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.
