Know When to Treat ‘Separate Procedures’ Separately

Turn to CCI for guidance if you’re in doubt about a bundle
The true meaning of a "separate procedure," as designated by CPT, is somewhat counterintuitive, which can cause a great deal of confusion for coders and physicians alike.
Avoid this mistake: Don’t assume that a "separate procedure" designation means you can always report the code separately if the physician provides the service. In fact, a separate procedure designation means that the procedure is bundled -- and therefore not separately reportable -- anytime the physician provides a more extensive, related service.

Learn the Right Time to Unbundle

CPT designates "separate procedures" as those procedures that the physician normally performs as an integral part of another, more extensive procedure. Therefore, the only time you should report a separate procedure "separately" is when your surgeon provides it independent of any related procedure(s), says Joyce L. Jones, CPC, CPC-H, CCS-P, CNT, director of business operations for AMSURG in Nashville, Tenn.
"You need to pay attention to the description of the CPT code for separate procedures," Jones says.
"Think of it like a Happy Meal," says Betty A. Johnson, CPC, CCS-P, CIC, CCP, president and principal consultant of CPC Solutions Inc. "You can either be billed for a hamburger alone (the separate procedure) or be billed for a combination that bundles a hamburger with fries and a drink (the more extensive related service)."
Example 1: The physician performs laparoscopic jejunostomy (44186, Laparoscopy, surgical; jejunostomy [e.g., for decompression or feeding] [APC 0131]) along with laparoscopic lysing of adhesions (44180, Laparoscopy, surgical, enterolysis [freeing of intestinal adhesion] [separate procedure] [APC 0131]).
In this case, you cannot report 44180 separately. The separate procedure designation for this code means that it is bundled to the related, more extensive procedure (44186).
Example 2: An orthopedic surgeon performs an arthroscopic lateral meniscectomy (29881, Arthroscopy, knee, surgical; with meniscectomy [medial OR lateral, including any meniscal shaving] [APC 0041]) along with arthroscopic lysis of adhesions (29884, ... with lysis of adhesions, with or without manipulation [separate procedure] [APC 0041]) in the same compartment.
In this case, you cannot report 29884 separately. The separate procedure designation for this code means that it is bundled to the related, more extensive procedure (29881).
Bonus tip: "Don’t forget about specific anatomical site," Johnson says. For example, a physician performs bilateral diagnostic arthroscopies (29870, Arthroscopy, knee, diagnostic, with or without synovial biopsy [separate procedure] [APC 0041]). On the left knee, however, she also performs a medial meniscectomy (29881).
You would report only 29881 for the left knee because the diagnostic arthroscopy would be bundled into it, Johnson says. "But [...]

- Published on 2008-01-15