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Thread: Separate Procedure

  1. #1

    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.

  2. #2
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  3. #3
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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 08:55 AM.

  4. #4

    Default

    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.

  5. #5

    Default Separate Procedure

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

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