Seperate procedure CPT guideline

Seperate procedure is the label given in some CPT in the CPT book.

Lets learn when and how to use seperate procedure .

Seperate procedure are considered to be :

1. Incidental

2. Bundled into a larger procedure

The seperate procedure are bundled or included in below condition and not need to code seperately

1. If performed in the same session with Larger or extensive procedure

2. If performed through the same incision of larger or extensive procedure.

3. If performed at the same anatomical site of larger or extensive procedure.

When to report seperate procedure :

1.If it is the only procedure performed .

2.It is completey distinct or unrelated such as

• Different anatomical site

• Different incision

• Opposite side (right vs left)

• Different condition

Example 1 : CPT 29805 is the Arthroscopy diagnostic procedure and 29806 Arthroscopy, shoulder, surgical; capsulorrhaphy procedure ?

So, if both the procedure is performed on the same side let say right shoulder, so you can't billed both, because here 29805 is label as seperate procedure and it is integral component of all other therapeutic shoulder arthroscopy procedure.

But if it is performed on other side let say left shoulder then you can code both CPT, because it is different side.