When is a separate procedure code

Hot Topics Toggle navigation. Print Post. Author Recent Posts. Latest posts by admin aapc see all. August 22, at pm. August 26, at pm. Harish says:. April 10, at am. These include:. About Foundation Museum of the Eye. About Our Coding Experts About Our Coding Experts Our expert staff have decades of combined experience, covering all aspects of coding and reimbursement.

David B. Email coding aao. Testing Services. Check this out with your practice management software vendor. Always use the most up-to-date version of the NCCI when checking for edits. Also, check your commercial payors to determine if they follow these edits. Even if a designated separate procedure triggers an NCCI edit, you may still be able to report the service separately if:. For example, if the diagnostic scope and the surgical scope procedure were performed in separate knees, may be billed separately with modifier appended because it represents a separate anatomical location.

You could also apply the appropriate LT left side and RT right side modifiers to both the and to designate which procedure occurred on which knee. Rules and Guidelines exist for a reason: to guide us to the correct and compliant way of doing things. There are exceptions to the rules and knowing when to exercise those exceptions is what due diligence is for.

Comment on this article. Terry is the author of several coding and reimbursement publications, as well as a practice auditor for multiple specialty practices around the country. Register to listen.

Not true. First, you must consider: Were there other procedures performed during the same encounter? Did you consult the NCCI edits? The separate procedure may be truly separate, and that condition is identified by adding the modifier Distinct procedural service to the designated separate procedure code. Coding for such procedures is often error-prone as well. AAPC gives two examples to understand the situations when separate procedure is reported.

The first example tells about a shoulder impingement case in which an arthroscopic surgical debridement and synovial biopsy of the right shoulder are performed on the patient.