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ED Coding and Reimbursement Alert

Reader Question:

Billing Starred Procedure

Published on Tue Feb 01, 2000

Question: Is the exam of the affected area in a starred (*) procedure included in the procedure code? Can we bill an evaluation and management (E/M) level with a starred procedure?

Anonymous California Subscriber

Answer: CPT states that when the starred procedure is carried out at the time of the initial visit and the procedure constitutes the major service at that visit, code 99025 (initial [new patient] visit when starred [*] surgical procedure constitutes the major service at that visit) is listed in lieu of the usual initial visit code as an additional service.

Medicare does not pay the code 99025 in any setting. Most insurance carriers consider 99025 to be a facility charge and will not pay in the emergency department. In the scenario listed, there is not a significant and separate level of E/M service to justify billing a separate E/M code.
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