Reader Question: Learn to Code Without Starred Procedures

Question: Why did CPT decide to remove the stars next to certain procedures, and what does this mean for medical coders?

Kentucky Subscriber

Answer: In past CPT manuals, a star next to certain diagnostic tests and minor procedures has served as a "red flag" to alert you to short global periods (0-10 days). In 2004, CPT took off the stars, which means you'll have to change how you deal with global periods and modifier -25. Endocrinology coders will need to do three things:

1. Look up every code's global package to determine the number of days in the global period so you know if you need to use modifier -25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service).

2. Be extra careful when using modifier -25 to report an E/M service the same endocrinologist provides to the same patient on the same day as any minor procedure. There must be a distinctly separate and documented E/M service for you to use this modifier with a procedure or diagnostic test.

3. Make sure your endocrinologists are clearly documenting their E/M visits on the same day as procedures. When payers see modifier -25, they're likely to shoot the claim back and ask to see the documentation first.

Warning: The HHS Office of the Inspector General  has modifier -25 on its Work Plan and may target your practice if you report modifier -25 inappropriately.