EVALUATION AND MANAGEMENT (E/M) 10-AND-90 DAY GLOBAL SURGICAL CODES
Our Position
Congress should direct the Centers for Medicare & Medicaid Services (CMS) to adjust the evaluation and management (E/M) post-operative visits included in 10-day and 90-day global surgical codes to reflect the updated office/outpatient E/M code payment increases that were implemented on January 1, 2021. It is critical that CMS increase the E/M portion of the global codes because to do otherwise will:
- Disrupt the relativity in the fee schedule. Changing the values for some E/M services, but not for others, disrupts the relativity mandated by Congress as part of the Omnibus Budget Reconciliation Act (OBRA) of 1989 (P.L. 101-239), which was implemented in 1992 and refined over the past 27 years. In the past, every time the payments for new and established office visits were increased, CMS also adjusted the global surgery bundled payments to account for the increased values for the E/M portion of these codes.
- Create specialty differentials. The Medicare statute specifically prohibits CMS from paying physicians differently for the same work, and the “Secretary may not vary the . . . number of relative value units for a physicians’ service based on whether the physician furnishing the service is a specialist or based on the type of specialty of the physician.” Failing to adjust the global code payment is equivalent to paying some physicians less for providing the same E/M services.
- Conflicts with section 523(a) of MACRA. Through the Medicare Access and CHIP Reauthorization Act (MACRA), Congress required CMS to collect data on global codes. Notwithstanding this ongoing project, nothing in Section 523(a) of MACRA precludes CMS from making these equity adjustments to the global codes in the meantime.
- Process exists to re-evaluate “misvalued” codes. If CMS feels that specific global codes are “misvalued,” the agency should request the AMA’s RUC to review these codes to ensure the global payments accurately reflect the actual services being provided to patients.
ASCRS is working with the surgical community advocating that Congress should direct the CMS to adjust the values of the E/M post-operative visits included in 10-day and 90-day global surgical codes to reflect the updated office/outpatient E/M code payment increases that were implemented on January 1, 2021.
How it Impacts You
Because of the budget neutrality of the fee schedule and the high volume of E/M services billed, the overall increase to the standalone E/M codes has a significant redistributive effect, transferring value from procedure-based specialties to primary care. Based on an analysis conducted by the surgical coalition, ophthalmology is among the most negatively impacted specialties from the policies in the final rule. However, if the post-operative E/M visits are increased in the global codes, ophthalmology would see a 4.74% increase in Medicare payments for 2023.
ASCRS is partnering with the American College of Surgeons and the Surgical Coalition to advocate that the E/M standalone visit increases be applied to the E/M post-op visits included in the 10- and 90-day global surgery codes. We recently sent a letter to CMS expressing our concern regarding their continued failure to adjust the 10- and 90-day global surgery codes to reflect recent increases to the standalone E/M codes. We reiterate our request for CMS to increase all global surgery codes in the CY 2023 MPFS to incorporate these E/M increases. We note that if CMS does not believe that the post-operative visits are occurring for a procedure in the global period, then it should be sent to the AMA Relative Value Scale Update Committee (RUC) for review. Additionally, the letter included a compendium of comments, recommendations, and data analysis that the surgical community has shared with CMS over the years.