Understand Guidelines for Starred Procedures to Optimize Pay Up
Published on Sun Oct 01, 2000
When is a small procedure, such as a biopsy or an injection, considered minor, and what does it mean if the procedure is starred? Understanding the difference between these terms can help practices determine whether they can perform evaluation and management (E/M) visits during starred procedures, or whether they can perform a starred procedure and another procedure on the same date of service.
Guidelines for Starred Procedures With E/M Visits
Starred procedures are relatively simple surgical procedures that are rarely associated with complications. These include lumbar punctures (62270), ventricular punctures (61020, 61026, 61105, 61107), removal of tongs or halo applied by another physician (20665), and facet joint injections (20610, arthrocentesis, aspiration and/or injection; major joint or bursa, [e.g., shoulder, hip, knee joint, subacromial bursa]). They are designated in CPT by an asterisk following the numerical code.
CPT offers specific coding rules and provides that the fee includes the starred procedure only; that is, there is no global period associated with it. If the starred procedure is carried out at the time of an initial or established patient visit involving significant identifiable services, the appropriate visit can be listed with modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service).
But use of modifier -25 can be carrier-specific, says Catherine Giblin, president of Medical Consultants of America, a healthcare practice management and billing firm in Haddonfield, N.J. Giblin advises that practices check with their insurers regarding whether modifier -25 will be recognized when billing for E/M services with starred procedures.
For example, a neurosurgeon sees a new patient through the emergency room and subsequently admits the patient. The patient suffers from head trauma and requires insertion of an intra-cranial pressure (ICP) monitoring bolt. The catheter insertion does not constitute the major service for this patients care. A lot of time was taken, and the documentation supports an extensive history and physical, examination and medical decision-making. ICP monitoring is a measure of the swelling in the brain. If the ICP gets too high, blood cannot get to the brain, and the patient may die. ICP requires close monitoring, especially in the initial days of trauma.
Physicians should code 99233 (subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least two of the three key components: a comprehensive interval history, a comprehensive examination, medical decision-making of high complexity; physicians typically spend 35 minutes at the bedside and on the patients hospital floor or unit) with a
-25 modifier for the admission, and then 61107 (twist drill hole for subdural or ventricular puncture; for implanting ventricular catheter or pressure recording device; starred procedure) for [...]
