Neurosurgery Coding Alert

You may need to change the way you report starred procedures to private payers beginning Jan. 1, thanks to the AMA's deletion of starred procedure guidelines in the 2004 CPT manual. Although the change won't affect your Medicare billing for these procedures, you'll need to adjust your E/M reporting with these surgical services for some private payers.
 
"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.
 
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 surgeon 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 for minor or relatively simple procedures such as injections, lumbar punctures (62270) and chemodenervation (62280-62282).
 
Regardless of CPT guidelines, however, many payers - including Medicare - imposed a global period (of zero or 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 adopted the Medicare practice of including certain services (including related E/M services and routine postprocedure care) as a regular part of all procedures. "For example, coders usually needed to use modifier -25 when billing an E/M service with a starred procedures, regardless of CPT guidelines," Bucknam says.
 
The AMA's CPT Changes 2004: An Insider's View, confirms Bucknam's view, stating, "The starred procedure designation was deleted for CPT 2004 in order to eliminate a duplicate method of reporting minor surgical procedures performed on the same day as an [E/M] service. Deletion of this designation will allow for the consistent use of the modifier '-25' appended to the E/M service code ..."
 
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.
 
Note: For complete information on starred procedure guidelines, see Neurosurgery Coding Alert, September 2003. Although the article pre-dates CPT changes for 2004, the information remains accurate.