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Coding & Billing
Billing for Multiple Procedures Under the New Payment System
Lolita Jones
Publish Date: November 17, 2007   |  Tags:   Financial Management

Much will change come January when ASCs begin using Ambulatory Payment Classification groups. There's a lot of bundling and discounting with APCs, plus a fair number of procedures that are defined as incidental and therefore not billable. There will be times, however, when you can report additional codes when you perform multiple procedures on the same patient. You must know which codes trigger additional APC payment and also have sufficient documentation in the OR report. Here are a few examples.


Suction assisted lipectomy; trunk

Multiple trunk site liposuction. You can report code 15877 for each area of liposuction on the trunk. You should append distinct procedural service modifier -59 to the subsequent procedures performed. (Source: February 2005 CPT Assistant newsletter, AMA).


Excision of cyst, fibroadenoma, or other benign or malignant tumor, aberrant breast tissue, duct lesion, nipple or areolar lesion (except 19300), open, male or female, one or more lesions

Multiple breast lesion excisions. Use modifier -59 to report excisions of benign tumors or cysts of the breast which require multiple incisions during the same operative session, using code 19120 with modifier -59 to identify the separate incisions. (Sources: May 2001 CPT Assistant newsletter, AMA; April 2005 CPT Assistant newsletter, AMA).


Correction, hallux valgus (bunion), with or without sesamoidectomy; with metatarsal osteotomy (Mitchell, Chevron or concentric type procedures, for example)


Osteotomy, with or without lengthening, shortening or angular correction, metatarsal; first metatarsal

Two first metatarsal osteotomies. This is for bunion correction and for severe metatarsus primus varus. During first metatarsal osteotomy bunionectomies (CPT code 28296), proximal osteotomies in the base of the first metatarsal (CPT code 28306), often required for severe metatarsus primus varus (>15 degrees), are done through a separate incision at a more proximal anatomic area. These can be reported separately and require a -59 modifier (28306-59). (Source: December 1996 CPT Assistant newsletter, AMA).


Blepharoplasty, upper eyelid


Blepharoplasty, upper eyelid; with excessive skin weighting down lid (higher reimbursement than code 15822 under the new payment system)

Upper eyelid blepharoplasty with superior visual field obstruction. See code 15823 for an upper eyelid blepharoplasty that is performed for the removal of excess, redundant skin from the upper eyelid. This fold of skin may mechanically weight the lid, causing it to droop, and obscuring the superior portion of the visual field. Often removal of this fold of skin will lead to resolution of any eyelid drooping. The two skin edges are then sutured together. A blepharoplasty procedure often includes the removal of orbital fat as well as the excess skin. (Source: September 2000 CPT Assistant newsletter, AMA).


Percutaneous implantation of neurostimulator electrode array, epidural

Multiple spinal electrodes. CPT code 63650 can be reported twice when two neurostimulator electrode catheters are placed through two separate sites. The CPT coding system makes no distinction as to the number of sites required for the placement of electrode catheters (Source: March 1999 CPT Assistant newsletter, AMA).

Computer-assisted planning for stereotactic surgery. Code 61795 describes computer-assisted planning for stereotactic surgery. This planning may take about 1 to 2 hours and includes determination of the coordinates for the target measurement of the anterior commisure-posterior commisure (AC-PC) line, and angle calculation. Using a computer, various trajectories are determined to assist the physician in choosing the specific trajectory and calculating the entry point through the skull. (Source: CPT Changes 2000: An Insider's View, AMA).


Stereotactic computer-assisted volumetric (navigational) procedure, intracranial, extracranial or spinal (List separately in addition to code for primary procedure)

Report code 61795 when performed in conjunction with ENT, head and neck procedures, including functional endoscopic sinus surgeries (FESS). Examples would include those procedures described by codes 31254-31256, 31267, 31276, 31287, 31288, 31290-31294 and 61548. (Source: October 2001 CPT Assistant newsletter, AMA).


Tendon transplantation or transfer, flexor or extensor, forearm and/or wrist, single; each tendon


Arthroplasty, interposition, intercarpal or carpometacarpal joints


Transfer or transplant of tendon, carpometacarpal area or dorsum of hand; without free graft, each tendon

Tendon transfer during intercarpal arthroplasty. Code 25447 is performed by excising part of one or more of the respective bones and then inserting soft tissue, such as an