Ob-Gyn Coding Alert

Youre coding a recent surgery and want to be sure you include everything that was actually done during the operative session. As your finger walks down the CPT page you find the right code, but then, in parenthesis, you see the words (separate procedure). What exactly does this mean? Can you use this code? At first glance the wording separate procedure is confusing. It seems to suggest the procedure merits coding distinct, separate and in addition to whatever else was done in the operative session. But thats not correct. A code designated as a separate procedure should not be reported in addition to the code for the total procedure or service of which it is considered an integral component. In other words, the only time you can use a separate procedure code is when its the only code in that family of codes you use.

For example, lets say the surgery you are coding for is laparoscopy (56300-56323). If the surgery is diagnostic in nature and nothing else is performed at that site then you would use the 56300 (diagnostic lap) because it is designated as a separate procedure and the only code in the laparoscopy family that applies. If the procedure included the fulguration of the oviducts and a biopsy you cannot use 56300. Instead use 56301 for the fulguration and 56305 for the biopsy. But lets also say that in addition to the fulguration and biopsy, intestinal adhesions were lysed. 56310 is a new code specifically for enterolysis (freeing abdominal adhesions) but it is also designated as a separate procedure. So in this case you could not use it. The only time you would use 56310 is when it is the only procedure done during the laparoscopy and then its the only code in the laparoscopy family you would report.

Note: Some payers will only consider paying for lysis of adhesions when the procedure involves extensive work with dense and vascular adhesions.

Occasionally there will be a situation where you report a separate procedure in addition to other procedures or services that are distinct and unrelated. In other words, if the other procedure or service is a completely different procedure, or distinct incision or excision site, or involves a totally different organ system. For example, if a total abdominal hysterectomy is performed and at the same time an enterocele is repaired (and is distinct and not related to the TAH) then you will report the primary procedure, the abdominal hysterectomy first and then the enterocele (the separate procedure) using the -59 modifier.