This commentary is a summary prepared by McKesson’s Revenue Management Solutions division and highlights certain changes, not all changes, in 2013 CPT® codes relating to the specialty of anesthesiology and pain management. This commentary does not supplant the American Medical Association’s current listing of CPT® codes, its documentation in the annual CPT Changes publications, and other related publications from American Medical Association, which are the authoritative source for information about CPT® codes. Please refer to your 2013 CPT® Code Book, annual CPT® Changes publication, HCPCS Book and Payer Bulletins for additional information, including additions, deletions, changes and interpretations that may not be reflected in this document.
CPT is a registered trademark of the American Medical Association (“AMA”). The AMA is the owner of all copyright, trademark and other rights to CPT® and its updates.
“Separate Procedure” in CPT Coding
Many CPT codes include the term “separate procedure” in the description of the procedure or service. What does this mean? In order to determine if a code described as a separate procedure should be reported, you first must review the documentation to see why the provider is doing the separate procedure. Does the primary procedure encompass the separate procedure?
Let’s first take a look at the CPT definition for separate procedure along with the Centers for Medicare & Medicaid Services (CMS) description:
In conclusion, it is always important to understand the CPT-designated separate procedure codes since many of these are considered part of the primary procedure. In many cases Medicare, will not include these ‘separate procedure’ codes into the NCCI edits, therefore leaving this up to the coder to recognize these situations.
Courtney Reasoner, CHC, CPC
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