Don't Let Starless Codes Deter Separately Reporting an E/M

Why This Topic Matters

The topic matters because the removal of starred procedures may affect claim handling, documentation expectations, and payer review for separate E/M and related services. Readers in coding and reimbursement roles need to understand the broad implications for claims involving procedures, anesthesia-related services, and postoperative care.

Article Sections

1. Eliminated starred procedure concept docks payment

   Introduces the CPT change that removes the starred procedure concept and describes the broader reimbursement context. It also contrasts the change with Medicare policy and carrier behavior.

2. Don't Dismiss E/M Codes Altogether

   Discusses how the policy change may affect separate reporting of evaluation and management services in procedural encounters. The section focuses on emergency department settings and the relationship between evaluation and treatment decisions.

3. Consider History When Billing Separate E/M

   Explains the importance of history, examination, and documentation when evaluating whether a separate E/M service may be supported. It emphasizes clinical context in emergency care.

4. Justify Additional H&P

   Addresses documentation and payer concerns that may arise when separate E/M reporting is considered for formerly starred procedures. It highlights the need for careful claim review and supporting records.

5. Keep an Eye Out for These Key Areas

   Identifies broad service categories that may face closer payer scrutiny after the CPT change. The section discusses anesthesia-related services and postoperative wound care-related services.