Oncology & Hematology Coding Alert

Try this strategy to get full ethical reimbursement from payers If you don't think -add-on- codes are particularly important and leave them off of your claims, you-re letting hard-earned dollars slip away. Stop the dollar drain with these pointers.
 
Term: CPT uses an -add-on- designation to identify services or procedures that always occur -in addition to- other services or procedures. You would never report an add-on code alone because it must accompany a designated -parent- code. Add-on codes can include the full range of CPT procedures, from E/M services to surgical procedures. Spot Add-On Codes by the -+-  To identify add-on codes in the CPT manual, you should look for a -+- symbol to the left of the code. Also, 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:

 - +96411 -- Chemotherapy administration; intravenous, push technique, each additional substance/drug (list separately in addition to code for primary procedure).  Rationale: You can't administer an -additional substance- without having an initial substance, so CPT lists the code for the additional substance as an add-on.
 
Some E/M services qualify as add-on codes, as well. For instance, prolonged service codes (such as +99354, Prolonged physician service ...; first hour; and +99355, ... each additional 30 minutes) are add-on codes, which means you must tag them to other E/M services, says  Catherine Brink, CMM, CPC, president of Healthcare Resource Management of Spring Lake, N.J.
 
Tip: For a complete list of add-on codes, consult CPT Appendix D. Don't Commit This Primary Procedure Code Crime You should never list an add-on code without also listing a code for a -primary- procedure. Rather, the add-
on code describes additional intraservice work or more involved work (as in the example below) associated with specific primary procedures the physician performs during the same patient encounter.
 
In most cases, the primary code(s) for a given add-on code immediately precede it in the CPT listings. For example, consider the following CPT code sequence:
 
- 96420 -- Chemotherapy administration, intraarterial; push technique

- 96422 -- - infusion technique, up to one hour

- +96423 -- - infusion technique, each additional hour.  In this case, the add-on code (96423) follows the related primary procedure code (96422).
 
And CPT includes an instructional note, -Use 96423 in conjunction with 96422.-

Be on the lookout for exceptions: CPT does not list all add-on codes near their primary procedure codes. In most cases, when CPT does not list the add-on code and primary codes together, the manual provides instructions on which codes should accompany the add-on code.

Example: CPT states that you should report +90767 (Intravenous infusion, for therapy, prophylaxis, or diagnosis [specify substance or drug]; additional sequential infusion, [...]