Medicare bundles (includes without separate payment) certain services and supplies when they are provided with other, more comprehensive services. According to the National Correct Coding Initiative (NCCI), Chapter 1 (General Correct Coding Policies):

Examples of services integral to a large number of procedures include:

– Cleansing, shaving and prepping of skin

– Draping and positioning of patient

– Insertion of intravenous access for medication administration

– Insertion of urinary catheter

– Sedative administration by the physician performing a procedure

– Local, topical or regional anesthesia administered by the physician performing the procedure

– Surgical approach including identification of anatomical landmarks, incision, evaluation of the surgical field, debridement of traumatized tissue, lysis of adhesions, and isolation of structures limiting access to the surgical field such as bone, blood vessels, nerve, and muscles including stimulation for identification or monitoring

– Surgical cultures

– Wound irrigation

– Insertion and removal of drains, suction devices, and pumps into same site

– Surgical closure and dressings

– Application, management, and removal of postoperative dressings and analgesic devices

– Institution of Patient Controlled Anesthesia

– Preoperative, intraoperative and postoperative documentation, including photographs, drawings, dictation, or transcription as necessary to document the services provided

– Surgical supplies, except for specific situations where [Centers for Medicare & Medicaid Services] CMS policy permits separate payment

For Medicare payers (and most others, as well), do not code any of the above procedures when provided during the same session as another procedure.