Separate Procedure Codes

September 5, 2013

Question:

Our surgeons work in a productivity employed model. I want to make sure I am capturing all the possible procedures to ensure correct coding and capturing the surgeons work. Recently the surgeon performed an exploratory laparoscopy CPT code 49320 and a laparoscopic cholecystectomy, CPT code 47562. CPT code 49320 has a separate procedure designation. I am unsure of how to report these procedures and am wondering if I should or should not be reporting 49320 in addition to the cholecystectomy.

Answer:

Great question and I am sure your surgeons are glad to have you on their team! You are correct though, to question this code combination. A procedure that has a “separate procedure” designation is considered inclusive to or integral to a more extensive surgery in the same area, same surgical setting. CPT code 49320 is not separately reportable for two reasons, 1) it has the separate procedure designation as you note and 2) it is also a diagnostic procedure. All surgical procedures include a diagnostic procedure. While the surgeon’s may have documented their exploration work, it would not be correct to report both codes to the payor.