"separate procedure"

[lindam@caricures.com]

In the coding book I am looking at 46040 - I &D of ischiorectal and/or perirectal abscess (separate procedure)

What does (Separate procedure) mean? I though I was allowed to bill 46020 along with it because it was a "separate procedure"

I need clarification of what that means in the coding book.

Thank you

 

[sls314]

In the coding book I am looking at 46040 - I &D of ischiorectal and/or perirectal abscess (separate procedure)

What does (Separate procedure) mean? I though I was allowed to bill 46020 along with it because it was a "separate procedure"

I need clarification of what that means in the coding book.

Thank you

"Separate procedure" means that the procedure is usually considered a component of a more extensive or related procedure.

The code exists so the service can still be reported when it is performed by itself without a more comprehensive related procedure.

In your example, the I&D of ischiorectal and/or perirectal abscess is considered part of the more extensive procedure represented by 46020.

So if the provider performed the more comprehensive procedure (46020), you would not also bill 46040 separately because that I&D is already included in 46020.

"Separate procedure" does not mean it should automatically be billed in addition to the main procedure. It actually means the opposite in most cases. It is generally only reported when performed independently from a more comprehensive related service.

If the only service performed was the I&D, and no more comprehensive related anorectal procedure was done, then 46040 could be billed by itself.