Radiology Coding Alert

Don't let deleted 'stars' disrupt your private-payer claims
 
The AMA has eliminated the "starred procedure" des-ignation from CPT - and if your private carriers used this designation to distinguish major and minor procedures, you'd better get an updated list of their global periods.
 
Prior to 2004, CPT Codes used the starred procedure designation (*) to identify a procedure or service that did not include any pre- or postprocedure care. Most often, CPT designated minor or relatively simple procedures such as venous intracatheter introduction (36000) and intraperitoneal catheter insertion (49420) with a star.
 
For example, when reporting a starred procedure code, such as CPT 43760 (Change of gastrostomy tube), the radiologist could separately report a documented E/M service at the time of the G-tube change, as well as any postprocedure care, even if those services were directly related to the tube change.
 
Regardless of CPT guidelines, however, many payers - including Medicare - imposed a global period (usually 0 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 some services.
 
Because the OIG intends to scrutinize claims with modifier -25 appended this year, you should pay extra attention to whether your E/M service is separately identifiable before you attach this modifier to any CPT codes.

Individual Carriers Can Set Globals

With the elimination of the starred procedure designation for 2004, CPT has left determining global periods up to the individual carriers. Because most payers didn't recognize CPT's starred procedure principle, most coders are already accustomed to appending modifier -25 to E/M codes when performed with other procedures, says Susan Callaway, CPC, CCS-P, an independent coding auditor and trainer in North Augusta, S.C.
 
The message for coders, then, is that although CPT will look different without starred procedures, for most insurers you will continue to code as you always have.
 
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 private insurers for their individual guidelines prior to submitting a claim.