Wiki Finger surgery question (seperate procedure rule)

[jovibon110@gmail.com]

If a procedure code has (separate procedure) but it doesn't bundle (NCCI) with the other code can you bill it? Example CPT code 26390 Right index finger flexor tendon resection and placement of silicone Hunter Rod and 26500 (separate procedure) Right index finger A1 pulley reconstruction. All the research only explains when you can unbundle using 59 mod.

 

[Orthocoderpgu]

While the NCCI edit is a useful tool, it does not contain all the answers either. Not every code combination that can't be billed together are incorporated into the NCCI edits. When something is listed as a "Separate Procedure" that procedure has to "Stand on its own" per se. In other words, there has to be "Clear Separation" between the codes. As a good general rule, if a procedure is marked "Separate Procedure" I would not bill it with another procedure performed in the same anatomical location unless it was performed through a separate incision or had its own surgical approach and has its own diagnosis.