CPT® 28820 – Amputation, toe; metatarsophalangeal joint
CPT® 28825 – Amputation, toe; interphalangeal joint
Both of these services have a zero day global period.
The global surgical package includes all the necessary services normally furnished by a surgeon before, during, and after a procedure. Medicare payment for a surgical procedure includes the pre-operative, intra-operative, and post-operative services routinely performed by the surgeon and members of the surgeon’s group who are of same specialty as the surgeon. Prior to of January 1, 2021 CPT 28820 and 28825 had a postoperative global period of 90 days. However, as of January 1, 2021, the postoperative global period for these procedures is 0 days.
This represented a major change for most practices. Prior to January 1, 2021, most practices had been submitting CPT 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 postoperative visits that occurred within 90 days of the performance of CPT 28820 and CPT 28825. Now, medically necessary evaluation and management services performed during the postoperative global period should be submitted with the appropriate level evaluation and management CPT code.
This change has resulted in both positive and negative outcomes. Providers have enjoyed the ability to submit payable CPT codes for providing medically necessary postoperative care. However, patients who have financial responsibility for evaluation and management services in the form of cost sharing have been burdened with copays and deductible payments for these visits in a way that did not occur when these visits were submitted with CPT 99024.
If you perform either or both of the procedures represented by CPT 28820 and 28825, be sure to code appropriately for the services performed during the postoperative global period.
References:
- MLN Global Surgery Booklet
- 2022 Medicare National Physician Fee Schedule Relative Value File
- 2022 CPT Professional. Current Procedural Terminology (CPT®) is copyright 1966, 1970, 1973, 1977, 1981, 1983-2021 by the American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association (AMA).
