Common Use of Starred Procedures May Differ From CPT Guildelines
Published on Mon Nov 01, 1999
Starred procedures often refer to relatively minor surgical services. While most surgical codes include a package of services, starred procedures are an exception to the rule. For these reasons, not all carriers interpret the concept the same way and often assign different global periods to starred procedures, says an AMA coding representative. To further confuse the issue, Medicare may consider the starred procedures inclusive in a global package of services.
The AMA designated some procedures with a star in CPT to indicate that the office code 99025 (initial [new patient] visit when starred surgical procedure constitutes major service at that visit) should be used when providing this procedure to a new patient, explains Thomas Kent, CMM, principal of Kent Medical Management, a medical office management and coding consulting firm in Dunkirk, MD.
First, Medicare considers that most starred procedures have 0- to 10-day global periods, but because most of these procedures are simple, 0 is the usual period, Kent explains. He points out that if the procedure is not on an existing body opening, the global period is 0, while if a minor incision is made, the period is 10 days. A patient with a burn receives daily treatment (16020*, burns, local treatment, without anesthesia, office or hospital, small), so the care is a starred procedure with 0 global days and may be billed for each day of the treatment.
Second, the starred procedures stand alone with no other procedures bundled into them, Kent continues. When you see a starred procedure, there are no other procedures with it. If an unrelated procedure occurs at the same time, you also can bill for it.
Finally, starred procedures often have office visits associated with them, either to evaluate possible associated injuries (i.e., a neurological exam accompanying a head laceration) or an unrelated problem. Be sure to separate your diagnoses. For example, a 45-year-old established female patient sees her family practitioner for a sore throat, and receives debridement for a burn. The family doctor can bill the appropriate established patient visit (99212-99215) with modifier -25, as well as 16020* for the burn.
Starred Procedures for New Patients
When the starred procedure is carried out at the time of an initial or other visit involving significant identifiable services, such as the removal of a small skin lesion, list the appropriate E/M visit in addition to the starred procedure and its follow-up care. The starred procedure is not necessarily the major reason for, or the only service performed during, the visit, explains Kent Moore, manager of reimbursement issues for the American Academy of Family Physicians (AAFP).
But when the starred surgical procedure constitutes the major service during the initial visit, CPT says, use 99025 as an [...]
