Policy Statement
A code determined to be incidental will not be eligible for separate reimbursement and will be denied as included in the allowance for the comprehensive procedure.
Centers for Medicare & Medicaid Services (CMS) National Correct Coding Initiative (NCCI) Policy Manual states that a procedure designated by CPT code descriptor as a “separate procedure” is not separately reportable if performed in a region anatomically related to the other procedure(s) through the same skin incision, orifice, or surgical approach.
Procedures or services considered incidental to a more comprehensive procedure include, but are not limited to, the following:
Codes identified as “separate procedure” are incidental when performed as part of another procedure and will not be separately reimbursed. For example:
- CPT code 45330 – Sigmoidoscopy, flexible: diagnostic… (separate procedure)
- CPT code 45331 – Sigmoidoscopy, flexible: with biopsy
- In this example, CPT code 45330 is incidental to CPT code 45331.
Procedures or services billed using an unlisted code will not be separately reimbursed when considered incidental to a more comprehensive procedure billed on the same date of service. For example:
- Unlisted CPT code 37799 is billed for implantation of a doppler for CPT code 15756 (Free muscle or myocutaneous flap with microvascular anastomosis). In this example, unlisted CPT code 37799 is considered incidental to the more comprehensive microvascular CPT code 15756.
- Unlisted CPT codes 17999 or 19499 billed for application of allograft, xenograft, or any other type of related material in the breast (or in other areas of surgery where there is not a specific code provided by CPT); the work of placement of the supportive material is considered an included component of the primary procedure and not separately reimbursed.
- Unlisted CPT code 76999 billed for esophageal Doppler hemodynamic management is considered incidental when performed with any anesthesia procedures.
References
Cross References
Adm 105 – Bundling Edits
Ane 102 – Anesthesia Reimbursement & Services Reporting
Mod 105 – Modifiers 59, XE, XP, XS, XU; Distinct Procedural Service
