Pediatric Coding Alert

Stars deletion tops CPT 2004's simplification push If you were thinking that the new CPT Codes Changes would further complicate your pediatric billing, think again. CPT 2004, effective Jan. 1, 2004, eliminates starred procedures, introduces new venipuncture requirements, clarifies after-hours reporting and updates vaccine codes - four changes that will simplify coding these services.
 
Here's what our experts say about applying these four changes:
 
1. Forget About Starred Procedures

In a move that will make surgical procedure coding easier and more consistent than before, CPT 2004 deletes the starred procedure designation, says Marie Felger, CPC, a coding consultant and American Academy of Professional Coders-certified coding instructor with Joy Newby & Associates LLC in Indianapolis. "You'll no longer have to think about handling surgical codes differently."
 
CPT previously used an asterisk to designate codes that contain the surgical procedure only, says Linda J. Walsh, MAB, division of healthcare finance and practice senior health policy analyst manager for the American Academy of Pediatrics (AAP) committee on coding and nomenclature in Elk Grove Village, Ill. Despite this designation, based on CPT's starred procedure guidelines, you still had to 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 established patient office visit codes (99212-99215, Office or other outpatient visit for the evaluation and management of an established patient ...) that involved significant identifiable services from a same-session procedure.
 
"The requirement seemed counterintuitive," Walsh says. Because a starred procedure contained no pre- or postprocedure work, a same-session E/M service should have been inherently separate from the surgery. Thus, CPT's modifier -25 requirement blurred the lines between a starred procedure and a nonstarred procedure, making the distinction unnecessary.
 
But some payers recognized starred procedures, says Victoria S. Jackson, administrator at Southern Orange County Pediatric Association in Lake Forest, Calif. For these insurers, you didn't have to use modifier -25 on an E/M code. If your pediatrician performed a starred procedure, such as wart removal (17000, Destruction [e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement], all benign or premalignant lesions [e.g., actinic keratoses] other than skin tags or cutaneous vascular proliferative lesions; first lesion), and an E/M service, for instance an established patient office visit (99212-99215, Office or other outpatient visit for the evaluation and management of an established patient ...), you didn't need to append modifier -25 to the procedure.
 
CPT's move, however, may cause insurers to stop accepting this billing method, which could cost pediatricians money, Jackson says. Unless payers increase previously starred procedures' relative value [...]