Optometry Coding & Billing Alert

Published on Thu Jan 01, 2004 PDF

Don't let deleted 'stars' disrupt your private-carrier reimbursement

The AMA has eliminated the "starred procedure" designation from CPT, and if your private carriers used this designation for major and minor procedures, you'd better get an updated list of their global periods.
 
Prior to 2004, CPT used the starred procedure designation (*) to identify a procedure or service that did not include any pre- or postprocedure care. Most often, CPT designated minor or relatively simple procedures.
 
Regardless of CPT guidelines, however, many payers - including Medicare - imposed a global period (usually 0 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 some services.
 
Beware: Individual Carriers Can Set Global Periods

Because most payers didn't recognize starred procedures, most coders are already accustomed to appending modifier -25 to E/M codes when performed with other procedures, says Susan Callaway, CPC, CCS-P, an independent coding auditor and trainer in North Augusta, S.C.
 
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.
 
The AMA has added a new radiology code, 76514 (... corneal pachymetry, unilateral or bilateral [determination of corneal thickness]), in addition to base code 76511 (Ophthalmic ultrasound, echography, diagnostic; A-scan only, with amplitude quantification).

While these changes are scheduled to take effect on Jan. 1, 2004, consult your carriers for their timetable for implementing these changes.