Neurosurgery Coding Alert

What if you could bill for services, such as follow-up E/M care, normally included in the global surgical package? When billing so-called "starred" procedures for payers that observe CPT guidelines, you can do just that - which can mean more reimbursement for your practice. Look for the '*' Before You Bill When you report starred procedures, charging separately for services normally included in the global surgical package is appropriate and warranted for some payers, even though coders are constantly warned against it. Starred procedures describe and include only the surgical procedure as listed in the CPT definition. "Associated pre- and postoperative services are not included in the service as listed," 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 or relatively simple procedures such as injections or needle biopsies. Common starred procedures familiar to neurosurgical coders include some drainages and aspirations (for example, 61000-61070), spinal punctures (62272-62273) and nerve blocks (64400-64415). Note: When an asterisk appears next to the first code in a series (e.g., 20550*-20553), the asterisk applies only to the code it appears next to, not the entire series. "The reasoning behind starred procedures was that practices could bill pre- and postoperative services separately, because the service rendered could vary widely between patients," says Susan Callaway, CPC, CCS-P, an independent coding consultant and educator in North Augusta, S.C. "For instance, because postoperative visits might not always be required, 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 any 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 neurosurgeon performs a diagnostic spinal tap (62270, Spinal puncture, lumbar, diagnostic) on an established patient. Prior to the tap, however, the surgeon performed a full E/M service related to the new patient complaint that prompted the spinal tap. Because the 62270 is a starred procedure, the E/M service is not included, and you may report it separately. In this case, you would report 62270 and 9921x-25 (you must select the appropriate E/M level as supported by the physician's documentation). 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, coding specialist at [...]