Ins & Outs of ‘Separate Procedure’ Designation

Mon, Mar 18, 2013 --

CPT Codes

Watch out:  Is your surgeon using a code that CPT® identifies with the words “separate procedure? Well, you need to check your claim carefully or you could face denials.

According to CPT® surgery guidelines, separate-procedure codes are services that are commonly carried out as an integral component of a total service or procedure…”  The CPT guideline also reads, “The designation restricts when and how you can report separate-procedure codes with any other related procedures.”

For example, in most instances, you shouldn’t use CPT code 44180 with other intestinal laparoscopy codes for the same patient on the same day.

Medicare also guides you on when to use separate-procedure codes. The codes listed as ‘separate procedure’ shouldn’t be reported in addition to the code for the total procedure or service. In other words, you should report a separate procedure if it’s not carried out with a primary procedure that covers the ‘separate’ one or when it adds ‘appreciably to the time and/or complexity of the procedure.

Medicare also sends across the message that if a CPT® code descriptor includes the term ‘separate procedure, you shouldn’t report the CPT® code with a related procedure. CMS interprets this designation to prevent the separate reporting of a ‘separate procedure’ when carried out with another procedure in an anatomically related region, often through the same skin incision, orifice, or surgical approach.

Know this: You may report a CPT® code with the “separate procedure” designation with another procedure if it’s carried out at a separate patient encounter on the same DOS or at the same patient encounter in an anatomically unrelated area.

What you can do: Add modifier 59 (Distinct procedural service) or a more specific modifier (For example anatomic modifier) to the “separate procedure” CPT® code to show that it merits a separately reportable service status.

About 

Barnali is a medical coding and billing writer at TCI who has worked in the healthcare industry since 2009. She holds a master’s degree in English literature and a diploma in advertising and marketing. She enjoys writing about ICD-10 and Medicare compliance.

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