What Does “Separate Procedure “Mean in a CPT Code Description?

Question:

What does “separate procedure” mean when it follows a CPT code description?

Answer:
Per CPT: 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, report the code in addition to other procedures/services by appending modifier 59 to the specific “separate procedure” code. This indicates 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).

What does this mean in practice?If a code description includes the term “separate procedure”, if that procedure is in the same anatomic area as a more comprehensive procedure (for example, lyse of adhesions followed by a colectomy) only the more comprehensive procedure, the colectomy, is reported.

*This response is based on the best information available as of 11/17/22.

Laparoscopic Pyloroplasty

Question:

How is a laparoscopic pyloroplasty reported? Can I use code 43800, Pyloroplasty?

Answer:

No, codes without the term laparoscopic in their description are intended as open codes and 43800 is an open code. There is no laparoscopic code for pyloroplasty so an unlisted code 43659 unlisted laparoscopic procedure, stomach, must be used.

*This response is based on the best information available as of 11/03/22.

Peritoneal Catheter Placement

Question:

I placed the peritoneal catheter for a neurosurgeon placing a V-P shunt. Do I code 49419, insertion of peritoneal catheter?

Answer:

No, you are a co-surgeon with the neurosurgeon. Code 62223, creation of a ventriculo -peritoneal shunt, includesboth the neurosurgeon’s portion of placing the ventricular catheter and your portion of placing the peritoneal catheter. Both surgeonswill report 62223-62.

*This response is based on the best information available as of 10/20/22.

Co Surgeon or Assistant?

Question:

A vascular surgeon is requested to come to the OR to repair a blood vessel that my surgeon inadvertently nicked during a colectomy. Is he a co-surgeon or assistant on the case?

Answer:

Neither. The vascular surgeon will report his work, repair of vessel, and you will report yours.

*This response is based on the best information available as of 10/06/22.

Choosing a Modifier with a Colostomy Revision

Question:

What modifier is used to report a colostomy revision during the global period of the stoma creation?

Answer:

A modifier 78, return to the OR for a related procedure, in this case a complication of the creation, would be appended.

*This response is based on the best information available as of 09/22/22.

Coding Mesh Placement in Hernia Repairs

Question:

If mesh is placed for a laparoscopic hernia repair can an unlisted code be reported for the mesh placement?

Answer:

No. All laparoscopic hernia repair codes include mesh placement so it would not be appropriate to bill for mesh separately.

*This response is based on the best information available as of 09/08/22.