What is considered a separate procedure?

A separate procedure designation identifies a procedure that may be performed independently or as part of a more extensive procedure, depending on the circumstances.

What is the XE modifier used for?

We define these modifiers as follows: XE – “Separate Encounter, a service that is distinct because it occurred during a separate encounter.” Only use XE to describe separate encounters on the same date of service.

How would you report two separate procedure codes that are unrelated to each other?

When circumstances allow reporting of a designated separate procedure, you must append modifier 59 Distinct procedural service to the separate procedure code. This alerts the payer that the separate procedure was performed as a distinct service and is unrelated to the major service (and is separately payable).

What is an unlisted procedure?

Unlisted codes are assigned when submitting claims for procedures/services where a CPT/HCPCS code is not otherwise specified. According to the AMA (American Medical Association) instructions for the CPT Code Set, select the names of the procedure/service that accurately identifies the service performed.

What are two reasons to use a separate procedure code?

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 CPT stand for?

Current Procedural Terminology
CPT® (Current Procedural Terminology)

When should modifier Xs be used?

Use of XS modifier. Modifier -XS is a subset of modifier -59. It is used to indicate a procedure should be reported separately with another procedure that it would typically bundle into because it was performed on a separate site.

What is an unlisted CPT?

Unlisted CPT codes are often used to represent new and emerging technologies for which U.S. Food and Drug Administration (FDA) approval has not yet been granted. Unlisted codes provide the means of reporting and tracking services and procedures until a more specific code is established.

How do you bill an unlisted procedure code?

When billing a service or procedure, select the CPT or HCPCS code that accurately identifies the service or procedure performed. If no such code exists, report the service or procedure using the appropriate unlisted procedure or Not Otherwise Classified (NOC) code (which often end in 99).

When the words separate procedure appear?

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.