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 reported the code 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).

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 2/14/19.

Fem- Fem Bypass

Question:

How is a left femoral to right femoral artery bypass with PTFE reported?

Answer:

Report code 35661, Bypass graft, with other than vein, femoral- femoral. This code applies to fem-fem bypass in the same leg or from one leg to the opposite leg.

*This response is based on the best information available as of 1/17/19.

Carotid Endarterectomy Coding

Question:

Can carotid endarterectomy, 35301, be billed more than once if plaque is removed from common, internal and external carotid?

Answer:

Code 35301, thromboendarterectomy, including patch graft, if performed, carotid, vertebral, subclavian, by neck incision, includes removing plaque at the carotid bifurcation and includes all removal from the common, internal and external carotid arteries.

*This response is based on the best information available as of 09/20/18.

Billing Vertebral Angiograms

Question:

Do I have to have the catheter is the vertebral artery to bill a vertebral angiogram?

Answer:

Not necessarily.  See the code descriptions below for vertebral imaging.  If the catheter is selectively placed in the subclavian or innominate artery and vertebral circulation is imaged and documented, code 36225 is reported. If the catheter is selectively placed in the vertebral artery and vertebral circulation is imaged and documented, code 36226 is reported.

CPT Code	Description	Vessels imaged
36225	Selective catheter placement, subclavian or innominate, unilateral	Ipsilateral vertebral circulation, including arch
36226	Selective catheter placement vertebral artery, unilateral	Ipsilateral vertebral circulation, including the arch

*This response is based on the best information available as of 05/17/18.

Coding Carotid Angiography

Question:

I performed a right common carotid artery catheterization with extracranial common carotid and intracranial imaging and left internal carotid catheterization with carotid circulation imaging. Can I report this as bilateral, 36224 and 36223-50?

Answer:

The bilateral modifier is only used for the exact same procedure/code performed bilaterally.

In your scenario the codes will be:

36224	for the left internal carotid catheterization with intracranial imaging, and
36223-59	for the right common carotid artery catheterization with extracranial and intracranial imaging

*This response is based on the best information available as of 12/14/17.

Coding Debridement for an Ulcer

Question:

I debrided and ulcer. How do I know if I use 97965 or 11042?

Answer:

Code 97597 is described by CPT as adebridement(e.g., high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), open wound, (e.g., fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm), including topical application(s), wound assessment, use of a whirlpool, when performed and instruction(s) for ongoing care, per session, total wound(s) surface area; first 20 sq cm or less.By definition it is exclusively for selective debridement of the skin, epidermis and dermis.

In contrast, code 11042, is for a deeper selective debridement, one that includes the dermis, epidermis and subcutaneous tissue. The code description statesDebridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less.

For any debridement make sure to document the depth of the tissue debrided, the location of the debridement and the size of the debridement. Other selective debridement codes (11043 and 11044) are also coded by the depth of tissue removed; muscle and/or fascia for 11043 and bone for 11044.

*This response is based on the best information available as of 09/21/17.