Definition

Distinct Procedural Service

Appropriate Usage

• Append when documentation indicates two separate procedures performed on same day by same physician
  • Represented by a different session or patient encounter, different procedure or surgery, different site, or separate injury (or area of injury)
• Append to secondary, additional or lesser procedure of combinations listed in National Correct Coding Initiative (NCCI) edits
  • Indicate 0 means a Correct Coding Modifier (CCM) is not allowed
  • Indicate 1 means a Correct Coding Modifier (CCM) is allowed
  • Indicator 9 means the use of a CCM is not specified
• Append when there is NO other appropriate modifier
• Append on second initial injection procedure code when IV protocol requires two separate IV sites or when patient has to come back for a separately identifiable service

Inappropriate Usage

• Code combination not appearing in NCCI edits
• Submission of E/M Codes
• Submission of weekly radiation therapy management codes (CPT 77427)
• The NCCI tables lists procedure code pair with a modifier indicator of "0"
• Documentation does not support the separate and distinct status
• Exact same procedure code performed twice on same day
• Multiple administration of injections of same drug
• When a more specific modifier exists to identify the services

Resources

• CMS Internet Only Manual (IOM), Medicare Contractor Beneficiary and Provider Communication Manual, Publication 100-09, Chapter 5, Correct Coding Initiative, section 20.4
• National Correct Coding Initiative Edits