Primary Care Coding Alert

Stars deletion tops CPT 2004's simplification push

 If you were thinking the new CPT code changes would further complicate your family practice billing, think again. CPT 2004, effective Jan. 1, 2004, eliminates starred procedures and introduces new biopsy guidelines and tendon sheath injection revisions - three changes that will simplify coding these services. Here's what our experts say about applying these three changes:
 
1. Take Stars Off Your Charge Slip

In a move that will make surgical procedure coding easier and more consistent, CPT 2004 deleted the starred procedure designation, says Marie Felger, CPC, a family practice coding consultant and American Academy of Professional Coders (AAPC) 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 Heather Findlay, CPC, CCP, coding specialist at Family Health Centers in Okanogan, Wash. Technically, if your family physician (FP) performed a starred procedure, such as wart removal (17000, Destruction [e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement], all benign or premalignant lesions [e.g., actinic keratoses] other than skin tags or cutaneous vascular proliferative lesions; first lesion), 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 postsurgery work, a same-session E/M service was inherently 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.
 
Most payers, however, didn't recognize CPT's starred procedure principle, Felger says. "Therefore, FP coders usually appended modifier -25 to the E/M code even if CPT designated the procedure as starred."
 
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.

2. Report a Biopsy With Unrelated Skin Procedures

You may have an easier time separately reporting a biopsy that your FP 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 resulted in confusion as to whether you could report a same-session biopsy and excision on the same anatomic area. The instructions clarify that you should report a skin biopsy code when your FP performs the biopsy alone or with another unrelated or distinct skin procedure.
 
For instance, your FP biopsies a lesion on a patient's hand and excises a benign lesion on the patient's arm, which he submits for pathology. You should report both the lesion excision (such as 11400, Excision, benign lesion including margins, except skin tag [unless listed elsewhere], trunk, arms or legs; excised diameter 0.5 cm or less) and the unrelated hand 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 FP 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). 

3. Assign 20550 per Tendon Sheath Injected

If you struggle with coding tendon sheath injections, CPT 2004 may spell relief. CPT again (CPT 2002 and 2003 revised 20550; CPT 2002 introduced 20551) revised codes 20550-20551 in another attempt to clarify the intent of these codes as they relate to multiple injections. In 2004, the codes will read: