Understanding the Differences between Starred and Minor Procedures Will Optimize Pay-up
Published on Thu Jul 01, 1999
When is a small surgical procedure, such as a hysteroscopy or biopsy, considered minor, and when is it considered starred? Understanding the difference between those termsas well as who created them and whyhas major coding and billing implications, stresses Susan Callaway-Stradley, CPC, CCS-P, senior consultant for the Medical Group of Elliott, Davis and Co., LLP, in Augusta, GA, and the recently named American Association of Professional Coders (AAPC) 1998 Coder of the Year.
For example, when an ob/gyn performs an endometrial biopsy in your office, can you charge an office visit (99201-99215) in addition to the procedure code (58100*) by appending modifier -25 (separate, significantly identifiable service) to the E/M code? There are endless variations on this principal behind coding for starred procedures, points out Diana Barnes, coder for Laurel Ob/Gyn Associates, a three-physician ob-gyn practice in Charlotte, NC.
For example, Barnes asks, Because the asterisk in CPT indicates the code represents a surgical procedure only, can we also bill an E/M code when a colposcopy (57452*) is performed in the office? Likewise, can we bill an E/M code when an established patient needs dilation of the cervix (57800*) in order to obtain an adequate Pap smear sample?
Such questions cause stress to physicians and coders alike. The doctor is anxious to have a resolution to the questions and I am at a loss as to how it should be handled appropriately, Barnes says.
Why does this issue have ob/gyns and their coders in such a state? For one thing, modifier -25 may get the E/M service paid, but you might not want to cash the check just yet. The Office of the Inspector General (OIG) began auditing Medicare claims last fall for misuse of this modifier. In its plan of action, the OIG reported that physicians are deliberately billing this modifier in cases where it does not apply for the sole purpose of increasing reimbursement.
On the other hand, there are times when using modifier -25 with a starred procedure is perfectly appropriateand if you fail to bill it out of fear, then your practice is losing reimbursement to which it is ethically entitled.
Its vital that coders understand the difference between CPT and Medicare rules in order to bill correctly, says Melanie Witt, RN, CPC, MA, program manager for the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists (ACOG).
CPT Guidelines for Starred Procedures
Starred procedures are relatively simple surgical procedures that are rarely associated with complications. They are designated in CPT by an asterisk following the numerical code, she explains.
These procedures may or may not require postoperative care, and follow-up care may vary by procedure, condition or patient. (See [...]
