Forum - Questions & Answers
44130 & 44120
My doc is asking why we cannot bill for a intestinal bypass (44130) with a resection and anastamosis (44120) at the same time. Although he understands the CCI edits, he explains the work is being done on two separate sections of the bowel and significant work is involved. I don't know how to explain this. Anybody have a idea that may help him understand this?
re: 44130 & 44120
CPT® “Separate Procedure” Definition
If a CPT® code descriptor includes the term “separate procedure”, the CPT® code may not be reported separately with a related procedure. CMS interprets this designation to prohibit the separate reporting of a “separate procedure” when performed with another procedure in an anatomically related region often through the same skin incision, orifice, or surgical approach.
A CPT® code with the “separate procedure” designation may be reported with another procedure if it is performed at a separate patient encounter on the same date of service or at the same patient encounter in an anatomically unrelated area often through a separate skin incision, orifice, or surgical approach. Modifier 59 or a more specific modifier (e.g., anatomic modifier) may be appended to the “separate procedure” CPT® code to indicate that it qualifies as a separately reportable service.