Harvard Pilgrim would like to remind our provider network that if a procedure code’s description includes the term “separate procedure,” that code should not be reported when performed alongside another procedure in an anatomically related region. A separate procedure is typically considered an integral component of a comprehensive service and therefore should not be reported separately.
Procedure codes designated as a “separate procedure” are eligible for separate reimbursement only when they are performed on the same day but at a different session, or at an anatomically unrelated site.
When it is appropriate and supported by the medical documentation, please report a separate procedure by appending one of the following modifiers, which are more descriptive subsets of modifier 59 created to allow for more precise documentation:
- Modifier XE – Separate Encounter
- Modifier XS – Separate Organ/Structure
For more information, please refer to Harvard Pilgrim’s Coding Overview and Surgery Payment Policies.