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General Surgery Coding Alert

No Stars to Guide You in 2004? Here's What to Do

Published on Thu Jan 01, 2004

You may need to change the way you report starred procedures to private payers beginning Jan. 1, thanks to the AMA's deletion of starred-procedure guidelines in the 2004 CPT manual. Although the change won't affect your Medicare billing for these procedures, you'll need to adjust your E/M reporting with these surgical services for some private payers.
 
Prior to 2004, CPT used the starred-procedure designation (*) to identify a procedure or service that did not include any pre- or postprocedure care. For example, when reporting a starred procedure, such as incision and drainage (I&D) for a superficial perianal abscess (46040), the surgeon could bill separately for a documented E/M service performed at the time of the drainage as well as any postinjection care, even if those services were directly related to the incision and drainage.
 
Most often, CPT used starred codes for minor or relatively simple procedures such as introduction of intracatheter or central venous catheters (36000, 36488-36489), injection of sclerosing solution to treat hemorrhoids (46500), and various biopsies (for instance, 47000, Biopsy of liver, needle; percutaneous).
 
Regardless of CPT guidelines, however, many payers - including Medicare - imposed a global period (usually of zero or 10 days) on starred procedures. This meant that when reporting an E/M service at the same time as a starred procedure, physicians had to meet the requirements of and append modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the appropriate E/M code to gain separate payment for the service.
 
Similarly, Medicare would bundle postprocedure care within the global period to the initial procedure. Only when the patient required a return to the operating room for postprocedure complications during the global period could a physician expect separate payment, and then only by appending modifier -78 (Return to the operating room for a related procedure during the postoperative period) to the appropriate procedure code.
 
With the elimination of the starred-procedure designation for 2004, CPT has conceded to the Medicare practice of including certain services (including related E/M services and routine postprocedure care) as a regular part of all procedures. "The starred-procedure concept really didn't affect coding because most payers ignored it," says Marcella Bucknam, CPC, CCS-P, CPC-H, CCA, HIM program coordinator at Clarkson College in Omaha, Neb. "For example, coders usually needed to use modifier -25 when billing E/M with starred procedures, regardless of CPT guidelines."
 
But some payers do not keep pace with CPT updates. Workers' compensation payers, for instance, often operate using guidelines that may be several years old, says Marvel J. Hammer, RN, CPC, CHCO, owner of MJH Consulting, a healthcare reimbursement consulting firm in Denver. For this reason, you may wish to contact any workers' comp insurers for their individual guidelines prior to submitting a claim.
 
Note: For complete information on starred-procedure guidelines, see General Surgery Coding Alert, October/November 2003. Although the article predates CPT changes for 2004, the information remains accurate.

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