A CPT code is designated as a ‘separate procedure.’ When may the physician-office coder report it independently?
Select an answer to reveal the explanation.
Short Explanation
‘Separate procedure’ is CPT’s polite way of saying ‘alone when it really stands alone.’ If it is just a stepping-stone inside a bigger related service, leave it on the shelf; if it truly ran on its own, then it can hitch a ride on the claim.
Full Explanation
CPT ‘separate procedure’ designations mean the service is commonly a component of a more extensive related procedure and should not be reported when it is integral to that larger service at the same session. It may be reported when performed independently or not as a component of another service. This concept applies to professional coding judgment and is not limited to facility claims or replaced by casually assuming every NCCI pair is payable. Coders should read the descriptor and session documentation before unbundling a separate-procedure code.