When multiple surgeries are performed on the same patient during the same operative session, the highest valued procedure is reimbursed at 100%, and additional procedures are reimbursed at 50%. For example, if a patient undergoes a rotator cuff repair (Code 23412), a ligament release (Code 23415), and a claviculectomy (Code 23120), the codes should be reported as follows: 23412, 23415 - 51, 23120 - 51.
The payment for a surgical procedure includes a standard package of preoperative, intraoperative, and postoperative services. For major surgeries, the preoperative period is 1 day, and the postoperative period is 90 days. For minor surgeries, the postoperative period is either 0 or 10 days, depending on the procedure.
If an unplanned procedure is performed during surgery, it should be documented and coded separately if it meets the criteria for separate coding and reimbursement. For example, during an exploratory laparotomy (CPT code 49000), if the surgeon discovers and performs a resection of an unexpected tumor, a separate code (such as CPT code 49203) should be used.
Modifiers provide additional information about the procedure. For example, in a bilateral breast reduction (CPT code 19318) where both breasts require reduction, the modifier -50 is used to indicate a bilateral procedure.
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