One of our pediatric providers did a I&D 10060 on a patient. They came back twice within a week and saw another of our pediatric providers for follow up appts. The second doctor is charging 99214 then second visit a 99213 for this patient. She "squeezed out some discharge however did NOT perform another procedure. I told her the patient was under the 10 day global and could not charge the E/M codes. She looked up something about "starred * " procedures (I have not heard of starred * procedures). She said the 10060 was ok for her to bill since it was a starred surgical procedure and that pre-op and post-op care is not included in the code. If it had been a 10061 then she couldn't of billed. I'm so confused does anybody know about this. My CPT® book doesn't show any "stars" asterisk by the procedures is there a list somewhere? Please help.
Thank you for your help. Yes I got the same answer from AAPC this is an old reference. I guess still on the "Internet" on supercoder. You know what goes on the internet stays there for ever. I will have to make my doctor understand this is old information. Thanks
You should ask for the software like EncoderPro to help with coding. AMA's software was great but they closed it down. Another thing that is helpful is to sign up for the doctors specialty association website. They always keep you up to date on their codes. For instance, I work for Neurosurgeons, so they are a member of AANS and I attend all their coding classes to keep me up to date.
Good luck to you!
The starred procedures in CPT® made their exit in CPT® 2004. You can use modifier -25 on the E/M code to show that the pts' condition required a separately identifiable E/M code if done on the same date as a procedure code being performed and billed, if the E/M code is for something other than the same Dx being a post-op follow-up. For the latest info, refer to CPT® Assistant November 2003- the last official publication re starred procedures. From the info you gave above, I think the provider who did the follow-up visits during a global period should have billed the OV with 99024 which is a post-up follow-up and no monetary value. Because the Dr who did the follow-up visits s within a week is with the same group of providers who did the original I&D, I believe the follow-up bills will be denied by the insurance payor. and you might have to write it off if your Drs' group is contracted with the insurance carrier billed. I don't know if there is a global on 10060 or not, if there is, you cant bill for post-op care during those days with any E/M code besides 99024. I don't have a RVU book anymore to look up global days by CPT® codes.
I don't code for DR offices anymnore - I code for facilities (the hospital or surgery center) - so I could be wrong here. I worked for DR offices in the 90s and things have changed since then! Your Drs should understand that coding rules are constantly changing and the billing personnel must stay current with new rules and regulations. Books from years ago that worked years ago no longer work now! That's "progress."