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Old 11-20-2009, 11:04 AM
coderguy1939 coderguy1939 is offline
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Default Separate Procedure

Does anyone have any guidelines/information on coding Separate Procedure codes. The information under Surgery Guidelines have always been very vague to me.

I have an op report where the doc has done an IOL exchange, 66986, and followed it up with a ciliary sulcus fixation of the IOL. It seems to me that since the purpose of surgery is to replace a dislocated lens, the ciliary sulcus fixation would be "an integral component of a total service" but coding 66986 with 66682 does not conflict w/CCI edits.

Input/advice/reference material would be appreciated.
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Old 11-24-2009, 07:17 AM
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http://www.cms.hhs.gov/NationalCorre...modifier59.pdf
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Old 11-24-2009, 07:46 AM
RebeccaWoodward* RebeccaWoodward* is offline
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CPT “Separate Procedure” Definition

If a CPT code descriptor includes the term “separate procedure”, the CPT code may not be reported separately with a related procedure. CMS interprets this designation to prohibit the separate reporting of a “separate procedure” when performed with another procedure in an anatomically related region often through the same skin incision, orifice, or surgical approach.

A CPT code with the “separate procedure” designation may be reported with another procedure if it is performed at a separate patient encounter on the same date of service or at the same patient encounter in an anatomically unrelated area often through a separate skin incision, orifice, or surgical approach. Modifier 59 or a more specific modifier (e.g., anatomic modifier) may be appended to the “separate procedure” CPT code to indicate that it qualifies as a separately reportable service.

http://www.cms.hhs.gov/NationalCorrectCodInitEd/

Chapter 1 of the NCCI Manual

......(Looking at CPT...it reads almost the same....hmmm...)

Last edited by RebeccaWoodward*; 11-24-2009 at 07:55 AM.
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Old 11-24-2009, 08:18 AM
coderguy1939 coderguy1939 is offline
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Thank you both for your responses.

The Separate Procedure definition is what I was trying to get additional clarification on. Mary (Mbort) sent me info from Marge Scalley that helped me sort it out.

Thanks again.
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Old 02-08-2010, 10:02 AM
smallard smallard is offline
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Default Separate Procedure

Coderguy, did the info you received from Margie Vaught lead you to only code the 66986?
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