General Surgery Coding Alert

What if you could bill for services, such as follow-up E/M care, that are part of global surgical packages? When billing so-called "starred" procedures for payers that observe CPT guidelines, you can do just that - which can mean more reimbursement for your surgery practice. Look for the '*' Before You Bill When reporting starred procedures, you may appropriately charge separately for services normally included in the global surgical package for some payers, even though coders are constantly warned against it. Starred procedures describe and include only the surgical procedure as described by the CPT definition. "Associated pre- and postoperative services are not included in the service," according to CPT surgery guidelines.
 
You can identify starred procedures easily by looking for an asterisk (*), or "star," to the right of the code in CPT. Most often, starred codes represent minor procedures such as injections or needle biopsies. Common starred procedures familiar to surgical coders include introduction of intracatheter or central venous catheters (36000, 36488-36489), injection of sclerosing solution to treat hemorrhoids (46500) and various biopsies (for instance, 47000, Biopsy of liver, needle; percutaneous).
 
Note: When an asterisk appears next to select codes in a series (e.g., 46900*-46922), the asterisk applies only to those codes it appears next to, not the entire series.
 
"CPT created starred procedures because services could vary widely from one patient to the next. By 'unbundling' pre- and postoperative services from the procedure, practices could report only the necessary services," says Susan Callaway, CPC, CCS-P, an independent coding consultant and educator in North Augusta, S.C. "For instance, because not all patients require postoperative visits, CPT doesn't automatically bundle such visits to starred procedure codes, but allows you to charge separately for them if necessary." Apply Modifier -25 for Same-Day E/M Services Because starred procedures do not include pre- or postoperative services, you may report an E/M service at the same time, but only if you append 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 appropriate E/M code, according to CPT.
 
For example, the surgeon performs an incision and drainage (I&D) for a superficial perianal abscess (46050) on an established patient. Prior to the I&D, however, the surgeon performed an E/M service for a new patient complaint that prompted the procedure. Because the 46050 is a starred procedure, the E/M service is not included, and you may report it separately. In this case, you would report 46050 and 9921x-25. Anticipate E/M Service Denials
 
Reporting starred procedures and E/M services for the same date of service can present a challenge at times, says Beth Fulton, CPC, a coding specialist in Winston-Salem, N.C. "When we bill [...]