tci ED Coding & Reimbursement Alert - 1999 Issue 11

Reader Question: E/M Level and a Starred Procedure

Question: Is the examination of the affected area in a starred procedure included in the procedure code? Can we bill an E/M level with a starred procedure?Anonymous OH SubscriberAnswer: CPT states that when the starred procedure is carried out at the time of the initial visit and the procedure constitutes the major service at that visit, procedure number 99025 is listed in lieu of the usual initial visit as an additional service. Medicare carriers do not pay this code in any setting. Most insurance carriers consider 99025 to be a facility charge and will not pay for it...

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