tci ED Coding & Reimbursement Alert - 2003 Issue 7

Reader Questions: Let the Star Guide You Except When Reporting to Medicare

Question: If a patient presents in the ED for a gastro tube change, can I bill the tube change (43760) and an emergency department E/M service (99281-99285)?Louisiana Subscriber Answer: You can charge an E/M when your physician performs a separately identifiable service from the other procedure codes. According to CPT, 43760* (Change of gastrostomy tube) is a starred, or minor, procedure. When the star follows a code, the service listed includes the surgical procedure only. This means payers that follow the starred/non-starred guidelines will pay you for services that represent any pre- and postoperative services for the procedure...

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