Certain Current Procedural Terminology (CPT) codes, when designated as a “separate procedure,” indicate that the service is typically considered an integral component of a more comprehensive procedure. However, if the service is performed independently, or distinctly apart from other procedures during the same encounter, it can be reported separately. For example, a diagnostic arthroscopy, designated as a “separate procedure,” may not be billable if performed during a more extensive surgical arthroscopic procedure. However, if performed on a separate knee during the same operative session, it may warrant separate reporting.
The designation ensures coding accuracy and prevents duplicate billing for services inherently included within a primary procedure. It aids in fair reimbursement practices by allowing independent, clinically significant services to be recognized and compensated appropriately. The concept evolved to standardize billing practices and minimize discrepancies in how procedures were coded and reimbursed, fostering greater transparency between healthcare providers and payers.
