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Chiropractic Coding & Compliance Alert

Reader Question:

Understand Separate Procedure For Correct Coding

Question:  What do we mean by “separate procedure”?

Wyoming Subscriber

Answer: According to the CPT® definition, “The codes designated as ‘separate procedure’ should not be reported in addition to the code for the total procedure or service of which it is considered an integral component.”

However, when a procedure or service that is designated as a ‘separate procedure’ is carried out independently or considered to be unrelated or distinct from other procedures/services provided at that time, procedures/services by appending modifier 59 to the specific ‘separate procedure’ code to indicate that the procedure is not considered to be a component of another procedure.

Routine muscle and range of motion testing is a component of a physical examination within the E/M service. However, in such routine examinations there could be findings that indicate a need for more definitive and quantifiable data. In such cases, these “separate procedure” codes are appropriate and accurate expressions.