Coding translator time
The separate procedure guidelines generally apply when one procedure that is designated as a “separate procedure” in CPT is done with another procedure, rather than with an E/M service as in your situation. If the designated separate procedure is an integral part of the other procedure that is done, the separate procedure is not separately reportable. However, if the separate procedure is done independently or otherwise unrelated to the other procedure done at the same session, the separate procedure may be coded separately with modifier -59 attached. For example, if a physician removes the impacted cerumen in an ear to do a tympanostomy (69433) on the same ear, the cerumen removal would probably not be separately reportable. However, if a physician performs cerumen removal on one ear and a tympanostomy on the other, both codes could be submitted with modifier -59 attached to the cerumen-removal code to indicate that it was a “distinct procedural service” done at a different anatomical site from the tympanostomy.
JOIN THE AAFP CODING DISCUSSION LIST
An AAFP e-mail discussion list is available for you and anyone you work with who has an interest in procedure (CPT/ HCPCS) and diagnosis (ICD-9) coding. The list is an unmoderated forum for participants to help each other with coding questions. It is open to anyone, including nonphysicians and physicians who are not AAFP members.
To join the list, send an e-mail to firstname.lastname@example.org and type "SUBSCRIBE coding [your first and last name]" in the body of the message (not the subject line). Once the subscription request is approved, you will receive another e-mail from the system confirming the subscription and providing guidelines, instructions, etc.
ICD-9 “omit code”
Editor’s note: While this department attempts to provide accurate information and useful advice, third-party payers may not accept the coding and documentation recommended. You should refer to the current CPT and ICD-9 manuals and the Documentation Guidelines for Evaluation and Management Services for the most detailed and up-to-date information.