Advanced Search

ED Coding and Reimbursement Alert

Reader Question:

E/M Level and a Starred Procedure

Published on Mon Nov 01, 1999

Question: Is the examination of the affected area in a starred procedure included in the procedure code? Can we bill an E/M level with a starred procedure?

Anonymous OH 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, procedure number 99025 is listed in lieu of the usual initial visit as an additional service. Medicare carriers do not pay this code in any setting. Most insurance carriers consider 99025 to be a facility charge and will not pay for it in the ED. Code 99025 should not be used for ED visits because the code definition specifies initial (new patient) visit when starred surgical procedure constitutes major service and the ED site of service does not recognize new patient or established patient designations.
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in your eNewsletter
  • 6 annual AAPC-approved CEUs*
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more
*CEUs available with select eNewsletters.

Other Articles in this issue of

ED Coding and Reimbursement Alert

View All