Part B Insider (Multispecialty) Coding Alert

Published on Mon Nov 03, 2003 PDF

Get ready to justify modifier -25 for E/M after minor surgeries

If your practice performs lots of minor surgeries, prepare to get starstruck - the star will soon be struck from the CPT book for those procedures. 
 
The CPT Editorial Panel hopes to phase out the "starred" designation from all surgical procedures over the next few years (See PBI, Vol. 4., No. 24, p. 157). Coding experts say this marker was always a source of confusion. But they worry that the change will mean a drop in reimbursement for physicians (see story, "Will RVUs Go up for Formerly Starred Procedures?").
 
The removal of the starred procedures means the CPT panel finally recognized that "no one uses starred procedures as defined by CPT," says Susan Callaway, an independent coding auditor and trainer in North Augusta, S.C. In particular, all post-op services, including wound checks, were supposed to be separately billable. But many payers have bundled them with starred procedures.
 
Because it didn't reflect the realities of coders' work, the starred procedure concept "created more problems than it was worth," Callaway says. It seems as though the CPT panel has realized "that life is easier for everyone if the concepts in the book reflect more closely the realities of day-to-day work with carriers." The starred procedure "is an extinct concept," and leaving it in the book "just confuses everyone," Callaway says.
 
"It's going to put a lot more pressure on crisp, complete documentation that will appropriately justify the -25 modifier (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service)," says consultant Robert Burleigh with Brandywine Consulting in Malvern, Pa. Without the starred designation, all of these procedures "will essentially be global," forcing providers to justify evaluation and management services using a modifier.
 
It won't necessarily make life easier to use modifier -25, Callaway agrees. Even under the old starred procedure rubric, the use of that modifier was always interpreted the same way. "Any carrier-specific interpretation is always up to them, and they are not likely to change."
 
"The global assignment for what were previously starred procedures is going to be very short," Burleigh says. It'll probably be one to 10 days.