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Separate Procedure

  1. #1
    Default Separate Procedure
    Exam Training Packages
    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
    Huntington, WV

  3. #3
    North Carolina
    Is this what you're looking for?

    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.

    Chapter 1 of the NCCI Manual

    ......(Looking at reads almost the same....hmmm...)
    Last edited by RebeccaWoodward*; 11-24-2009 at 07:55 AM.

  4. #4
    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. Default Separate Procedure
    Coderguy, did the info you received from Margie Vaught lead you to only code the 66986?

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