ED Coding and Reimbursement Alert

Question: Please explain a starred procedure and how it would affect billing that procedure when performed in the emergency department. Also, what does not billing starred mean in the same instance, especially now with APCs?

Warren Cooper
Thomasville, Ga.

Answer: Starred procedures are surgical procedures that do not include preoperative and postoperative packaging in the cost of the procedure. When the starred (*) procedure is carried out at the time of an initial visit (new patient) and this procedure constitutes the major service at that visit, procedure number 99025 (initial [new patient] visit when starred [*] surgical procedure constitutes major service at that visit) is listed in lieu of the usual initial visit as an additional service. When the starred procedure is carried out at the time of an initial or established patient visit involving significant identifiable services, the appropriate visit is listed with modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) appended in addition to the starred procedure and its follow-up care. All postoperative care is added on a service-by-service basis (e.g., office or hospital visit, cast change). Complications are added on a service-by-service basis (as with all surgical procedures).

Remember that the starred procedure services and 99025 are not recognized by Medicare and may not be recognized by other carriers that closely follow HCFA guidelines. CPT has established that 99025 does not pertain to ED visits, which do not differentiate new and established visits. Thus, the appropriate evaluation and management (E/M) service should be identified. Therefore, with the introduction of APCs, this concept would not be recognized and is not applicable, since APC hospital billing and services are provided on the UB-92 claim form.