General Question for the Week of August 7, 2017

General Compliance Question of the Week

Question:

In terms of Medicare billing, what does it mean when a CPT® code descriptor includes the term “separate procedure”?

Answer:

According to the Centers for Medicare & Medicaid Services (CMS), when that phrase appears in the descriptor, the CPT code may not be reported separately with another related procedure in an anatomically related region often through the same skin incision, orifice, or surgical approach.

It 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.

 

CPT® is a registered trademark of the American Medical Association.

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.