Definitions

Definitions A. For purposes of this chapter Medicaid defines the following terms related to surgery as follows: 1. Add-on codes are procedures performed in addition to the primary service/procedure and are never reported as a stand-alone code. a) Add-on codes describe additional intra-service work associated with the primary procedure. b) Add-on codes are exempt from multiple surgery rules. 2. Assistant surgeon is a licensed physician who actively assists the physician in charge of a case in performing a surgical procedure. 3. Bilateral procedures are exact procedures identified by the same procedure codes which are performed on anatomically bilateral sides of the body during the same operative session. 4. Co-surgeons are two (2) surgeons, each usually in a different specialty, who are required to perform specific procedures during the same operative setting. Co-surgery also refers to surgical procedures involving two (2) surgeons performing the parts of the procedure simultaneously, such as bilateral knee replacements. 5. Endoscopic procedure is the performance of a procedure on interior organs and cavities of the body through an endoscope. 6. An endoscope is a flexible fiber optic instrument used to visualize the interior of a body cavity or organ. 7. Incidental procedure is a procedure carried out at the same time as a primary procedure, is clinically integral to the performance of the primary procedure or requires little additional physician resources. 8. Multiple deliveries are two (2) or more infants delivered from one (1) pregnancy. 9. Multiple surgeries are separate procedures performed by the same physician on the same patient at the same operative setting. Medicaid applies multiple surgery rules to certain procedure codes except for certain procedures exempt from multiple surgery rules. 10. Mutually exclusive procedures are the separate billing for two (2) or more procedures that are usually not performed for the same patient on the same date of service. 11. Team surgeon is a team of surgeons, more than two (2) surgeons of different specialties, required to perform a specific procedure. 12. Unbundled procedures are the use of two (2) or more procedure codes to describe a procedure or event when a single procedure code exists that comprehensively describes the surgery performed.