Neurosurgery Coding Alert

The true meaning of a "separate procedure," according to 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.

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.

National Correct Coding Initiative (CCI) guidelines specify, "A HCPCS/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."

"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 order a hamburger alone (the separate procedure) or order a -combo- that bundles a hamburger with fries and a drink (the more extensive related service)."

Example 1: As a basic example, you would not report a cisternal or lateral cervical puncture without injection (61050, Cisternal or lateral cervical [C1-C2] puncture; without injection [separate procedure]) -- which is a designated "separate procedure" -- at the same time as a similar puncture with injection (61055, - with injection of medication or other substance for diagnosis or treatment [e.g., C1-C2]). Common sense suggests that 61050 ("the hamburger") is bundled to the more extensive procedure, 61055 ("the Happy Meal"). Only if the surgeon performs a cervical puncture alone should you report 61050.

Example 2: The surgeon performs an exploratory craniectomy (61304, Craniectomy or craniotomy, exploratory; supratentorial) followed by placement of an intracerebral ventricular catheter (61210, Burr hole[s]; for implanting ventricular catheter, reservoir, EEG electrode[s], pressure recording device or other cerebral monitoring device [separate procedure]).

In this case, you cannot report 61210 separately. The separate procedure designation for this code means that it is bundled to the related, more extensive procedure (61304).

Rather than having to guess if a designated separate procedure is related (and therefore bundled) to another service that the physician provides on the same day, you can rely instead on the bundling edits listed in CCI, Jones says.

Bottom line: The CCI edits will tell you -- without a doubt -- if a "separate procedure" is included in another, more extensive procedure you wish to report.

Example: Your surgeon injects anesthetic into the carotid sinus (64508, Injection, anesthetic agent; carotid sinus [separate procedure]) and follows up with chemo-denervation of the facial nerve for hemifacial spasm (64612, Chemodenervation of muscle[s]; muscle[s] innervated by facial nerve [e.g., for blepharospasm, hemifacial spasm]). Although 64508 is a designated "separate procedure," how can you tell if it's bundled to injection procedure 64612, specifically?

A quick look at CCI reveals that 64508 is, indeed, a component of 64612. In this case, instead of reporting both injections separately, you-ll report the chemodenervation only because it is the more extensive procedure.