Neurology & Pain Management Coding Alert

Although the AMA's elimination of "starred procedures" for 2004 may have little effect when coding for Medicare payers, it may require you to make minor adjustments when billing some private or third-party insurers.
 
Prior to 2004, CPT used the starred procedure designation (*) to identify a procedure or service that did not include any pre- or postprocedure care. For example, when reporting a starred procedure, such as 62281* (Injection/infusion of neurolytic substance [e.g., alcohol, phenol, iced saline solutions], with or without other therapeutic substance; epidural, cervical or thoracic), the neurologist could bill separately for a documented E/M service performed at the time of the injection, as well as any postinjection care, even if those services were directly related to the injection.
 
Most often, CPT used starred codes to denote minor or relatively simple procedures like injections, including such things as lumbar punctures (62270) and chemo-denervation (62280-62282).
 
Regardless of CPT guidelines, however, many payers - including Medicare - imposed a global period (usually 10 days) on starred procedures. This meant that when reporting an E/M service at the same time as a starred procedure, physicians had to meet the requirements of - and 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 to gain separate payment for the service.
 
Similarly, Medicare would bundle postprocedure care within the global period to the initial procedure. Only when the patient required a return to the operating room for postprocedure complications during the global period could a physician expect separate payment, and then only by appending modifier -78 (Return to the operating room for a related procedure during the postoperative period) to the appropriate procedure code.
 
With the elimination of the starred procedure designation for 2004, CPT has conceded to the Medicare practice of including certain services (including related E/M services and routine postprocedure care) as a regular part of all procedures. "The starred procedure concept really didn't affect coding activities because most payers ignored it. I feel sure this is why CPT deleted it," says Marcella Bucknam, CPC, CCS-P, CPC-H, CCA, HIM program coordinator at Clarkson College in Omaha, Neb. "For example, coders usually needed to use modifier -25 when billing E/M with starred procedures, regardless of CPT guidelines."
 
But some payers do not keep pace with CPT updates. Workers' compensation payers, for instance, often operate using guidelines that may be several years old, says Marvel J. Hammer, RN, CPC, CHCO, owner of MJH Consulting, a healthcare reimbursement consulting firm in Denver. For this reason, you may wish to contact any workers' comp insurers for their individual guidelines prior to submitting a claim.
 
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