ED Coding and Reimbursement Alert

An article in the February 2002 issue of Emergency Department Coding Alert prompted reader questions about whether coders may report digital blocks in addition to services described by starred procedures. In the article, "Coding Outside the Box What's in a Global Package," coders were instructed to report 64450* (Injection, anesthetic agent; other peripheral nerve or branch) with 12001* (Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities [including hands and feet]; 2.5 cm or less). This recommendation is consistent with information published in the AMA's Principles of CPT Coding, 2nd Edition, page 101:

"What's included when a starred procedure is reported? The only service included when a starred procedure is reported is the actual procedure itself. The 'package,' as defined by the CPT nomenclature, does not apply when these codes are reported. This rule pertains to separately reporting not only associated preoperative and postoperative E/M services, but all the services included in the package definition (i.e., local infiltration, metacarpal/digital block or topical anesthesia, and normal, uncomplicated follow-up care)."

Instructions on page 53 of the 2002 CPT manual appear to contradict this. In its directions for use of simple repair codes, CPT states, "This includes local anesthesia and chemical or electrocauterization of wounds not closed."

To apply these directions appropriately, coders must distinguish between starred and nonstarred procedures. Starred procedures, by definition, encompass only the surgical service itself. Therefore, it is correct to bill the procedure and anesthetic separately (along with any E/M service provided), as noted in the example using 12001* in the February 2002 issue of ECA.

Conversely, nonstarred procedures are governed by surgical package rules, which state that services related to the central procedure are included in the CPT code. When you report codes describing nonstarred surgical procedures, the digital block should be included in the overall service and not reported separately. An example is 12035 (Layer closure of wounds of scalp, axillae, trunk and/or extremities [excluding hands and feet]; 12.6 cm to 20.0 cm).

Coders must remember that Medicare does not recognize the starred procedure classification. Therefore, digital blocks are bundled into Medicare's procedure reimbursement and may not be billed separately.