dimplez
Networker
Hello all - is it appropriate to report fasciectomy codes (either 28062 or 28060) with tarsal tunnel release even if those codes are labeled as 'separate procedures'? Our surgeon was doing these under one incision; however, once we shared this with him he began to do separate incisions and specifically emphasizes this within his operative notes. Any resources on this out there on this??
If the code descriptor of a HCPCS/CPT code includes the phrase “separate procedure,” the procedure is subject to NCCI PTP edits based on this designation. CMS does not allow separate reporting of a procedure designated as a “separate procedure” when it is performed at the same patient encounter as another procedure in an anatomically related area through the same skin incision, orifice, or surgical approach
Source: https://www.cms.gov/files/document/medicare-ncci-policy-manual-2023-chapter-3.pdf
Thank you!!
| CPT Manual Surgery Guidelines Separate Procedure (Surgery) |
| Some of the procedures or services listed in the CPT codebook that are commonly carried out as an integral component of a total service or procedure have been identified by the inclusion of the term "separate procedure." The codes designated as "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. |
| However, when a procedure or service that is designated as a "separate procedure" is carried out independently or considered to be unrelated or distinct from other procedures/services provided at that time, it may be reported by itself, or in addition to other procedures/services by appending modifier 59 to the specific "separate procedure" code to indicate that the procedure is not considered to be a component of another procedure, but is a distinct, independent procedure. This may represent a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries). |
If the code descriptor of a HCPCS/CPT code includes the phrase “separate procedure,” the procedure is subject to NCCI PTP edits based on this designation. CMS does not allow separate reporting of a procedure designated as a “separate procedure” when it is performed at the same patient encounter as another procedure in an anatomically related area through the same skin incision, orifice, or surgical approach
Source: https://www.cms.gov/files/document/medicare-ncci-policy-manual-2023-chapter-3.pdf
Thank you!!