Practice Management Alert

Medicare has clear guidelines for separate procedure.Having clear documentation of the procedures your surgeon is doing and why one procedure is being listed as a separate procedure in your claim will make all the difference in your claims success. Medicare has a clear definition about what constitutes a separate surgical procedure. According to Josie Dunn, CPC, at the University of Maryland Faculty Practices, Maryland, Medicare states: "The CPT® surgery guidelines further state that the codes listed as 'separate procedure' should not be reported in addition to the code for the total procedure or service. In other words, report a separate procedure if it is not performed with a primary procedure that encompasses the 'separate' one, or when it adds 'appreciably to the time and/or complexity of the procedure.'Below is what Heidi Stout, BA, CPC, COSC, PCS, CCS-P, Coder on Call, Inc., Milltown, New Jersey and director of orthopedic coding division, The [...]