Neurology & Pain Management Coding Alert

Did you know that you can bill for services, such as follow-up E/M care, that are part of global surgical packages? When billing so-called "starred" procedures for payers that observe CPT guidelines, you can do just that - which can mean more reimbursement for your neurology practice. Look for the '*' Before You Bill When reporting starred procedures, you may charge separately for services normally included in the global surgical package for some payers, even though coders are constantly warned against it. Starred procedures describe and include only the surgical procedure as described by the CPT definition. "Associated pre- and postoperative services are not included in the service," according to CPT surgery guidelines.
 
You can identify starred procedures easily by looking for an asterisk (*), or "star," to the right of the code in CPT. Most often, starred codes represent minor or relatively simple procedures such as injections. Common starred procedures familiar to neurology coders include lumbar punctures (62270) and chemodenervation (62280-62282).
 
Note: If a star appears next to the first code in a series of codes (for example, 20550*-20553), it applies only to the "starred" code, not to all codes in the series.
 
"CPT created starred procedures because services could vary widely from one patient to the next. By 'unbundling' pre- and postoperative services from the procedure, practices could report only the necessary services," says Susan Callaway, CPC, CCS-P, an independent coding consultant and educator in North Augusta, S.C.
 
"For instance, because not all patients require post-operative visits, CPT doesn't automatically bundle such visits to starred procedure codes, but allows you to charge separately for them if necessary," Callaway says. Apply Modifier -25 for Same-Day E/M Services Because starred procedures do not include pre- or postoperative services, you may report an E/M service at the same time, but only if you 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, according to CPT.
 
For example, the neurologist performs diagnostic spinal puncture (62270*, Spinal puncture, lumbar, diagnostic) on an established patient. Prior to the tap, however, the neurologist performed an E/M service for the patient complaint that prompted the procedure. Because the 62270 is a starred procedure, the E/M service is not included, and you may report it separately. In this case, you would report 62270 and 9921x-25. Anticipate E/M Service Denials
 
Reporting starred procedures and E/M services for the same date of service can present a challenge at times, says Beth Fulton, CPC, a coding specialist in Winston-Salem, N.C. "When we bill an E/M visit with modifier -25 along with a starred procedure, carriers sometimes deny the E/M," she says. "I appeal those [...]