Pulmonology Coding Alert

Question: What's the practical significance of losing the starred designation in CPT 2004? For example, I perform an E/M visit and a thoracentesis (32000, Thoracentesis, puncture of pleural cavity for aspiration, initial or subsequent), which was formerly a starred procedure. I would normally report 99213-25 and 32000. Now that CPT 2004 is effective and starred procedures are gone, what's the difference in coding?

Tennessee Subscriber

Answer: One of the problems with starred procedures was that CPT stated that these codes did not include any E/M services. On the other hand, CMS claimed that they included the preoperative services required to perform the procedure (if it had zero global days), and some of the starred procedures had 10 global days, according to CMS.

The AMA decided to simplify the coding language by reducing everything to basic definitions. Consequently, if you perform a procedure on the same day as an office visit, any E/M services would be included in the procedure code, such as 32000, unless your documentation shows that the E/M was unrelated to the procedure. In this case, you would add 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 E/M code. The modifier would identify the E/M service as separately identifiable.

If the pulmonologist saw the patient the same day as or the day before surgery, you could only bill the E/M services using modifier -57 (Decision for surgery). But remember that the documentation must show that the office visit was unrelated to the procedure's performance (for example, obtaining informed consent, explaining the procedure to the patient, etc.).

-- Answers for You Be the Coder and Reader Questions were reviewed by Carol Pohlig, BSN, RN, CPC, senior coding and education specialist at the University of Pennsylvania department of medicine in Philadelphia; and Alan Plummer, MD, chief of pulmonary disease, allergy and critical care at Emory University Hospital in Atlanta.