“Separate Procedure” Coding
Many codes within the CPT® codebook are designated “separate procedures” (e.g., 76000 Fluoroscopy (separate procedure), up to 1 hour physician or other qualified health care professional time, other than 71023 or 71034 (eg, cardiac fluoroscopy)). Such procedures may be reported if they are the only service provided, but may be bundled when provided at the same time as another procedure. How do you know if such procedures are bundled?
Per Chapter 1 of the national Correct Coding Initiative Manual, a designated separate procedure code may not be reported if the procedure occurs “in a region anatomically related to the other procedure(s) through the same skin incision, orifice, or surgical approach.”
When circumstances allow reporting of a designated separate procedure (e.g., the separate procedure occurs via a different incision, orifice, or surgical approach), you must append use a modifier (e.g., modifier 59 Distinct procedural service or modifier XS Separate structure) to the separate procedure code. This alerts the payer that the separate procedure was performed as a distinct service and is unrelated to the major service (and is therefore separately payable).
For example, you may report 29884 Arthroscopy, knee, surgical; with lysis of adhesions, with or without manipulation (separate procedure) by itself to describe excision of adhesions in the knee. But, you would not report (or be paid for) 28844 with another arthroscopic procedure in the same knee (e.g., 29877 Arthroscopy, knee, surgical; debridement/shaving of articular cartilage (chondroplasty)). If the lysis of adhesions and chondroplasty occurred in separate knees, however, you may report the codes separately by using an appropriate modifier (e.g., modifier XS for Medicare payers) to identify that the procedures occurred at different anatomical sites.
CPT Assistant (Sept. 2012) provides a coding scenario for proper reporting for separate procedure code 38100 Splenectomy; total (separate procedure)
A 36-year-old male who was in a motor vehicle accident arrives at the emergency department complaining of abdominal pain. A workup reveals a ruptured spleen. The patient is prepared for surgery and taken to the operating room where, after exploratory laparotomy, the decision is made to perform a splenectomy.