Neurosurgery Coding Alert

CPT is full of "add-on" codes, from minor and major surgical procedures to E/M services, but do you know the special rules that apply to these codes? If you can keep just four points in mind, you can gain the best possible reimbursement for your add-on procedures every time. Point 1: Identify Add-on Codes by the "+" To identify add-on codes in CPT, you should look for a "+" symbol to the left of the code. Also, all add-on codes contain a variation of the phrase "List separately in addition to code for primary procedure" in their CPT descriptors. A typical add-on code listing appears as follows:

+69990 -- Microsurgical techniques, requiring use of operating microscope (list separately in addition to code for primary procedure). "The 'plus' designation identifies those codes that the physician performs in addition to other, usually closely related, procedures or services," says Tara L. Conklin, CPC, an instructor for CRN-Institute, a coding and reimbursement institution offering courses in reimbursement, medical billing, outpatient coding certification and inpatient coding certification. "That's why they are called 'add-on' codes: You cannot report them alone, but always 'add them on' to another procedure or service."

Example: A surgeon would never use an operating microscope (69990) in the absence of a surgical procedure that required her to visualize a particular anatomic location. Because you would only bill 69990 in addition to another procedure, CPT lists the code as an add-on.

Some E/M services qualify as add-on codes as well. For instance, you may report prolonged services (such as +99354, Prolonged physician service ...; first hour; and +99355, ... each additional 30 minutes) only in addition to other, primary E/M services (such as an outpatient visit, consult, etc.).

Note: For a complete list of add-on codes, consult Appendix D of CPT. Point 2: Always List With a Primary Procedure As noted above, you should never list an add-on code without also listing a "primary" procedure. Rather, the add-on code describes additional intraservice work associated with specific primary procedure codes the physician performs during the same operative session or patient encounter, says Anita L. Carter, LPN, CPC, an instructor at A+ Medical Management and Education, a school for billing and coding in Absecon, N.J. In most cases, the primary code(s) for a given add-on code immediately precede the add-on code in the CPT listings. For example, consider the following CPT code sequence:

22520 -- Percutaneous vertebroplasty, one vertebral body, unilateral or bilateral injection; thoracic
22521 -- ... lumbar
+22522 -- ... each additional thoracic or lumbar vertebral body (list separately in addition to code for primary procedure). In this case, the add-on code (22522) follows the primary procedure codes (22520 and 22521) to which it is related. And, [...]