General Surgery Coding Alert

Question: What's the practical significance of losing the "starred designation" in CPT 2004? For example, if I perform an E/M visit and a liver biopsy (formerly a starred procedure), I would normally report 99213-25 and 47000. Now that CPT 2004 is effective and starred procedures are gone, what's the difference in coding?

Tennessee Subscriber

Answer: The short answer to your question is: Your coding will not change for Medicare carriers, and for private payers you will have to begin appending modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to any E/M service provided on the same day as another procedure.

CMS did not follow CPT guidelines concerning formerly "starred" procedures such as 47000, Biopsy of liver, needle; percutaneous. CPTguidelines stated that these procedures included no pre- or postoperative services, while CMS claimed that all services include -- at a minimum -- the preoperative services required to perform the procedure. CMS even assigned a global period of 10 days to many so-called starred procedures -- meaning that the procedures included postservice care as well.

AMA decided to simplify the coding language by reducing everything to basic definitions. Therefore, if you perform a procedure on the same day as an office visit, the  payer will include any E/M services in the procedure code unless your documentation shows that the E/M was unrelated to performing the procedure. In this case, you would add modifier -25 to the E/M code. You should use this coding for both Medicare and private payers (whereas, formerly, you would have needed to append modifier -25 for Medicare payers only).

If the surgeon 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 (such as obtaining informed consent or explaining the procedure to the patient).