Developing Codes to Capture Post-Operative Care

Testing New Codes to Capture Post-Operative Care

“…Based on the input of an expert panel, we proposed a new set of codes to CMS that combined scope of services with time, for both inpatient and office-based services. The rationale and description of these codes (nonpayment codes referred to as G-codes in this report) were summarized in a prior RAND report (Mehrotra et al, 2016). In July 2016, CMS issued a proposed rule that included a slightly modified version of the post-operative visit G-codes that RAND had developed for CMS (CMS, 2016a) and proposed to require their use by practitioners for certain services.…”

“…As part of the Medicare Access and CHIP Reauthorization Act of 2015, Congress mandated that CMS collect data on the "number and level" of visits in the global period from a representative sample of physicians beginning January 1, 2017. In order to support CMS in collecting data on the number and level of visits performed in the global period, the RAND Corporation had developed a set of nonpayment G-codes to capture setting, complexity, and time associated with post-operative visits in the global period (Mehrotra et al, 2016). In the 2017 Medicare physician fee schedule proposed rule, CMS proposed collection of data on postoperative visits using G-codes similar to those developed by RAND.…”

“…The vignettes were developed by members of the research team with clinical expertise and modeled after the type of vignettes used by the American Medical Association/Specialty Society Relative Value Scale Update Committee. Initial vignette development was informed by interviews performed during earlier work by the same research team (Mehrotra et al, 2016). The vignettes were all structured analogously, and described the reason for the patient visit, what was done during the visit, and how long it took to complete the various tasks and procedures performed (for vignette text, see Appendix A).…”

“…We conducted interviews by phone during late July and early August 2016 with a convenience sample of five physicians (one from each of the specialties) who had been interviewed for prior related work and had agreed to be contacted again as needed (Mehrotra et al, 2016).…”

“…In the first phase of this work (Mehrotra et al, 2016), CMS had asked the RAND Corporation to provide recommendations on how to best collect the number and level of postoperative visits through the use of nonpayment claims (i.e., G-codes, or nonpayment codes). To do so, RAND gathered input from individual practitioners and later an expert panel to describe the range of post-operative care provided during the global period.…”