Otolaryngology Coding Alert

Stars deletion, biopsy cuts top CPT 2004's simplification push

If you were thinking the new CPT code changes would further complicate your otolaryngology billing, think again. CPT 2004, effective Jan. 1, 2004, eliminates starred procedures and introduces new biopsy guidelines - two changes that will simplify coding these services. Here's what our experts say about applying these two changes:

1. Take Stars Off Your Charge Slip

In a move that will make surgical procedure coding easier and more consistent than before, CPT 2004 deleted the starred procedure designation, says Marie Felger, CPC, an American Academy of Professional Coders-certified coding instructor with Joy Newby & Associates LLC in Indianapolis. "You'll no longer have to think about handling surgical codes differently."
 
CPT previously used an asterisk to designate codes that contain the surgical procedure only, says Susan Callaway, CPC, CCS-P, an independent coding auditor and trainer in North Augusta, S.C. Technically, if your otolaryngologist performed a starred procedure, such as epistaxis control (for instance 30901, Control nasal hemorrhage, anterior, simple [limited cautery and/or packing] any method), and an E/M service, such as an established patient office visit (99212-99215, Office or other outpatient visit for the evaluation and management of an established patient ...), you didn't need to 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 procedure.
 
Because a starred procedure contained no pre- or postprocedure work, a same-session E/M service was separate from the surgery. Therefore, CPT didn't require you to use modifier -25 to designate the E/M service as separately identifiable from the surgery.

CPT Includes Minor E/M in All Procedures

Most payers, however, didn't recognize CPT's starred procedure principle, Callaway says. In fact, to override most computer systems, you had to append modifier -25 to the E/M code even if CPT designated the procedure as starred.
 
The stars' deletion brings CPT in line with Medicare, adds Barbara J. Cobuzzi, MBA, CPC, CPC-H, an otolaryngology coding and reimbursement specialist and president of Cash Flow Solutions, a medical billing firm in Lakewood, N.J. "Medicare never included starred procedures and always treated starred procedures as zero global-day codes," she says. By eliminating starred procedures, CPT 2004 also considers a procedure to include a small history, examination and medical decision-making, an inherent part of all operative codes. Therefore, when your otolaryngologist performs a significant, separately identifiable E/M service, you need to use modifier -25 on the code.
 
You also won't have to worry about reporting 99025 (Initial [new patient] visit when starred [*] surgical procedure constitutes major service at that visit) for a new patient visit at which a starred surgical procedure constitutes the major service at that visit. The CPT panel deleted the code in conjunction with the starred procedure designation.
 
To track follow-up visits, you may continue to use revised code 99024 (Postoperative follow-up visit, normally included in the surgical package, to indicate that an evaluation and management service was performed during a postoperative period for a reason[s] related to the original procedure). CPT's revision clarifies that you should use this code to report services that the surgical package includes and, hence, you shouldn't charge for.

2. Report a Biopsy With Unrelated Skin Procedures

You may have an easier time separately reporting a biopsy that your otolaryngologist performs during another integumentary procedure, thanks to a new CPT guideline that appears before the skin biopsy codes, 11100 (Biopsy of skin, subcutaneous tissue and/or mucous membrane [including simple closure], unless otherwise listed; single lesion) and +11101 (... each separate/additional lesion [list separately in addition to code for primary procedure]).
 
CPT 2004 eliminated 11100's "separate procedure" designation, which often caused confusion as to whether you could report a same-session biopsy and excision on the same anatomic area.

Use Modifier -59 for Separate Site Biopsy, Excision

CPT's revised biopsy instructions clarify that you should report a skin biopsy code when your otolaryngologist performs the biopsy alone or with another unrelated or distinct skin procedure.
 
For instance, your otolaryngologist biopsies a lesion on a patient's nose and excises a benign lesion on the patient's cheek, which he submits for pathology. You should report both the lesion excision (such as 11440, Excision, other benign lesion including margins [unless listed elsewhere], face, ears, eyelids, nose, lips, mucous membrane; excised diameter 0.5 cm or less) and the unrelated nose lesion biopsy (11100) appended with modifier -59 (Distinct procedural service) to indicate that the biopsy occurs on a different site from the lesion excision.
 
On the other hand, if your otolaryngologist excises, destroys or shaves a lesion and submits a tissue sample for pathologic examination in the process, CPT considers obtaining and submitting the tissue a routine component of the original integumentary procedure. In this case, you shouldn't separately report the biopsy (11100).