Compare and contrast Same Time, Different Operative Field with Same Time Same Operative Field

Question

What will be an ideal response?

Answer 1

Answer:
Same Time, Different Operative Field
When more than one surgery is performed during the same operative session but through a different orifice (opening) or incision or in a different operative field, 100% of the UCR is allowable for the major procedure, and 50% of the UCR (or actual charge, whichever is less) is allowed for the second procedure. 25% of UCR (or actual charge, whichever is less) is allowed for each additional procedure. Some insurance carriers, however, do not apply the 25% rule, allowing 100% for the primary procedure and 50% thereafter. Bilateral procedures have the same rules as multiple procedures performed through different incisions. Multiply the UCR allowance for the single procedure by 150% or 1.5. If there is an established bilateral CPT® code, that code would be allowable at 100% only because the units have already been assigned at 150% of the unit value for the single procedure. There are two ways to identify a bilateral procedure. The provider will list the CPT® and use modifier -50 to denote a bilateral procedure. Sometimes the provider will identify LT (left) or RT (right) next to each procedure. When in doubt, obtain an operative report.
Same Time, Same Operative Field
When multiple procedures are performed during the same operative session through the same incision, orifice, or operative field, the additional procedures are usually considered to be incidental.