May 27, 2021

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 designated as a “separate procedure” is carried out independently is (unrelated or distinct) the separate procedure may be billed. Append modifier 59 to the specific “separate procedure” code to indicate that the procedure is not considered a component of the other 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 05/27/21.