99024 CPT Code: How to Document for Wound Care

Health care providers are well-versed in the use of medical CPT codes in order to be reimbursed for any services they provide, particularly those that will be paid for by Medicare or Medicaid. In a 2012 study, the Office of the Inspector General (OIG) found that often the fees paid for global payment surgeries did not match the number of visits actually provided to a patient. This resulted in a recommendation to reduce the payment amount. Before taking this action, the CMS decided to collect more data.

In 2017, the 99024 CPT code was established to collect data about the frequency and effectiveness of the post-surgical care patients receive. CMS will use this collected data to make future decisions about the value of surgical services. Currently, they are billed globally—one payment for all the visits and procedures related to the surgery. Using the 99024 CPT code correctly ensures that the right data about the care patients received is coded, tracked, and accounted for in that global payment.

What Is 99024 CPT Code?

Current Procedural Terminology (CPT) codes are used by Medicare and other insurance providers to identify the medical procedures and services patients can receive and at what rate they pay for those services. These codes are each five characters long and can contain both letters and numbers. The purpose is to establish a consistent set of terminology to understand, track, and reimburse services provided. These are established and maintained by the American Medical Association to ensure consistency and a common language between providers and insurance companies.

CPT code 99024 is the code associated with post-operative follow up visits by any provider. This covers all evaluation and management visits including monitoring for infection, tracking wound healing, managing pain, and removing drains or catheters. While these are often done by the surgeon, if an anesthesiologist or other provider does any of the after-care for this procedure, they would also use this code. It is part of the global surgical package of codes and is not billed independently to patients but is tracked to ensure that appropriate follow-up services are provided to all surgery patients. The requirement to use this code started in 2017 and continues today.

Providers who meet the following criteria will need to understand and use the CPT code 99024 if:

• They practice in Florida, Kentucky, Louisiana, Nevada, New Jersey, North Dakota, Ohio, Oregon, or Rhode Island (These states were randomly selected by CMS to collect data on the use of the code and that appropriate post-surgical support is given).
• Ten or more practitioners are part of their medical group.
• They provide global services within the 10- or 90-day time frame to be considered part of the global package.

This code will be used by any practitioner who delivers post-operative care within the 10- or 90-day global time period and meets the stated conditions. For minor surgeries with a 10-day global period, count the surgery as day zero and start the 10-day period the day after the surgery. For major surgeries with a 90-day global period, the day before and the day of the surgery are covered, and the 90 days start the day after the surgery. The use of this code is not limited to the one who performed the original operation. These health care providers may be providing service in hospitals, SNFs, or outpatient clinics.

How to Use CPT Code 99024

The 99024 CPT code is specifically for a list of 293 procedures and their follow-up services. Review the list of codes that require 99024 follow-up regularly as the CMS can update them at the beginning of each year. These procedures were chosen because they are furnished by more than 100 health care providers, and either are furnished more than 10,000 times annually in the United States or have more than $10 million in annual charges.

In addition to providing the appropriate tracking information for CMS, using this code keeps practices compliant with medical billing and ensures that all necessary services are provided to post-operative patients. Surgeries are single fee events, but the related appointments and procedures still need to be documented as proof that all events covered in the global surgery package have been delivered to the patient. The follow-up provider will bill these services with original code as the surgery but include the 55 modifier. The surgeon should use the 54 modifier to indicate that parts or all of the post-operative care will be done by a different providers.

For 2025, a new code was created as an add-on for post-operative care. HCPCS code G0559 is for practitioners who did not participate in the surgery but provided follow-up care. This will help insurance companies and physician offices track the resources and time spent on these tasks.

If the patient required significant and separate services at the time of a post-operative visit, the modifiers 24 and 25 can be used to extend the billing for these resources. A new diagnosis will not need to be made. The documentation must show that what was provided was more than expected for a post-operative follow-up visit.

The 99024 CPT code has a zero-dollar amount associated with it because it is reimbursed with the global package. Documentation for these visits should focus on recovery and the continuation of the treatment plan, which makes it significantly different from the documentation for a standard evaluation. If any other services are provided, the administrator will need to use the modifier codes to be reimbursed for the additional treatment.

What Do Practitioners Need to Know About 99024 CPT Code’s Related Conditions?

The 99024 CPT Code is not necessary for every surgery code. These types of clinicians are likely to need this code if they practice in the chosen states.

• Plastic surgeons for excising lesions, skin grafts, or tissue transfer.
• Dermatologists for excising skin cancer or performing Mohs surgery.
• Podiatrists for removal of a nail bed, treating a toe fracture, or amputation of the toes.
• Ophthalmologists for removing lesions on the face, attaching ocular implants, or repairing eye lids.
• General surgeons for removing a nail, destroying lesions, or building a connection between a vein and an artery (arteriovenous anastomosis).
• Thoracic surgeons for lung resection.
• Cardiac surgeons for an artery bypass graft.

Remember that this code is just used for the surgery and the evaluation required for that procedure. If the patient needs to return to the operating room, develops an unrelated condition, or needs additional therapy, use modifiers or new codes as required to submit to the insurance companies for reimbursement.

Concerns about 99024 CPT Code

Because this code has no monetary value and is nestled within other codes for billable services, there has been concern that it is not used correctly or whether or not it’s possible to use this data to make decisions about the payment for surgery services. It also doesn’t apply across the board to all surgeons equally, creating confusion over who is required to use the code and in what situations it no longer applies.

Changing the CPT code creates an additional administrative burden on medical offices to learn the nuances and adapt their EHRs to match the changes. The use of this code is different than other medical codes, so some billing systems are not useful in this situation. Billing clearinghouses flag any documentation with a zero sum, creating administrative backlogs to manually check the work and approve it. Billing offices should ensure their EHR systems can correctly code these services and communicate accurate information to insurance companies.

For patients who are both admitted to the hospital and visiting a practitioner in private practice for surgery-related concerns, the hospital’s EHR in the hospital may not match the private practice’s EHR, making it more difficult to match the 99024 code to the original surgery package.

Surgeons are seeing more patients more frequently who have underlying health problems. Those with high blood pressure, infections, diabetes, and slow-healing wounds often require more visits and more intense treatment that is not accounted for in the standard surgical package payment. Using the 99024 CPT code means the provider is not paid for these services or non-patient facing work like reading x-rays or evaluating blood work results. Physicians have brought these issues to the attention of CMS for further evaluation on how surgical packages are billed and reimbursed.

Why It’s Essential to Use 99024 CPT Code Correctly

Medicare pays for services in advance as part of the global surgery package. The cost of follow-up services is calculated into the price, so they have a vested interest in making sure the care is provided. In 2019, the Centers for Medicare and Medicaid Services published a concern that the 99024 code was not used frequently enough to warrant its value.

While it doesn’t carry any monetary value to the practice because it is part of the global post-operative package, it is still tracked and analyzed. The code was not being used by practitioners who were providing these services, thus giving a negative impression in the data about the delivery of follow-up services. If CMS believes the services are not provided, they may decide to lower the value of the entire package because certain assumed services are not regularly delivered. The goal is to build an accurate reflection of the work physicians do before, during, and after surgeries and reimburse them correctly for those services.

The use of this code is regularly monitored through data mining techniques and the CSM will make decisions on payment and billing based on the frequency of use for the 99024 CPT code. If they find that the appropriate post-surgery care is not provided via this billing code, practices may be subject to reviews for the quality of their care and delayed or refused reimbursement for the original surgical codes.

If you provide post-operative services to patients in the eight selected states, double check how your EHR system uses the 99024 CPT code. These billing best practices will contribute to CMS continuing to financially support comprehensive post-operative care for all patients.