MULTIPLE/BILATERAL EXAMPLES

ADD-ON CODES: Certain codes, by the nature of their description and the unit values assigned, have already been reduced, as they are not to be billed as primary procedures. For a complete list of the codes which are considered to be add-on codes, refer to the appropriate appendix found within the most recent publication of the AMA Current Procedural Terminology (CPT). 

CODES THAT ARE NOT CLASSIFIED AS ADD-ON CODES BUT ARE EXEMPT FROM THE MULTIPLE PROCEDURE RULE / MODIFIER -51: For a complete list of the codes which fall into this category, refer to the appropriate appendix found within the most recent publication of the AMA Current Procedural Terminology (CPT).

CODES WHICH INCLUDE CONSCIOUS SEDATION: Certain codes include conscious sedation as an inherent part of providing the procedure. For a complete list of codes that include conscious sedation, refer to the appropriate appendix that is found within the most recent publication of the AMA Current Procedural Terminology (CPT).

FOLLOW-UP OR AFTERCARE: Follow-up care for therapeutic surgical procedures includes all normal postoperative care, that care which is usually a part of the surgical service. Complications, exacerbations, recurrence of the condition, or the presence of other diseases or injuries requiring additional services concurrent with the procedure may warrant additional charges. If such separate charges are made, explain by report with an adequate description. When an additional surgical procedure is performed during any follow-up care and is related to the previously performed procedure but is not an intrinsic part of the latter, the additional procedure will be paid at one-half the maximum allowable payment.  

The column headed AFUD@ reflects the amount of days that would be applicable for the particular type of surgical procedure and/or service provided. Note that some procedures show the AFUD@ as being XXX, YYY, or ZZZ. The following definitions, which correspond with the Medicare Fee Schedule, are incorporated within this fee schedule:

XXX = Reflects that the global surgery concept does not apply to these codes.   

YYY = Reflects that the global period (FUD=s) are to be set by the carrier. 

ZZZ = Reflects that the codes are an add-on service and are to be treated in the global period (FUD=s) of the other procedures that are billed in conjunction with the ZZZ code. 

SEPARATE PROCEDURE: Some of the procedures or services listed are commonly carried out as an integral component of a total service or procedure and are identified by the inclusion of the term Aseparate procedure.@ The codes designated as Aseparate 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 Aseparate procedure@ is carried out independently or considered to be unrelated or distinct from other procedures/services provided at that time, it may be reported by itself, or in addition to other procedures/services by appending modifier -59 to the specific Aseparate procedure@ code to indicate that the procedure is not considered to be a component of another procedure, but is a distinct, independent procedure. This may represent a different session or patient encounter, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries).