Wiki Add-on codes when base is secondary

[kenbeckman]

When CPT designates a code as Add-on with the '+' sign, the code is exempt from the multiple procedure concept. But the add-on codes are specific to one or more base codes.

CPT says that the add-on codes are always performed in addition to the primary service procedure.

What happens when the base code to which the add-on code is attached is not the primary surgical code but the base code is itself a secondary code subject to multiple procedure reduction?

As an example:
22802 - posterior arthodesis is primary
22214 lumbar osteotomy is secondary subject to multiple procedure reduction
BUT 22216 (billed for second and third level osteotomies) is an add-on code and NOT subject to multiple procedure reduction.

Logically, one should reduce the 22216 because the base code to which it is attached 22214 has already been reduced - but it does not work that way.

Thoughts would be greatly appreciated.

 

[mhstrauss]

When CPT designates a code as Add-on with the '+' sign, the code is exempt from the multiple procedure concept. But the add-on codes are specific to one or more base codes.

CPT says that the add-on codes are always performed in addition to the primary service procedure.

What happens when the base code to which the add-on code is attached is not the primary surgical code but the base code is itself a secondary code subject to multiple procedure reduction?

As an example:
22802 - posterior arthodesis is primary
22214 lumbar osteotomy is secondary subject to multiple procedure reduction
BUT 22216 (billed for second and third level osteotomies) is an add-on code and NOT subject to multiple procedure reduction.

Logically, one should reduce the 22216 because the base code to which it is attached 22214 has already been reduced - but it does not work that way.

Thoughts would be greatly appreciated.

Add-on codes should never be reduced. Period. Regardless of whether or not it's parent code is the primary code on the claim. In your example above, the physician is getting 100% reimbursement for 22802, which includes all pre-, intra- and post-op work associated with a surgery. 22214 should be reduced by 50%, so that the physician is not paid again for the the pre- and post-op work that he is already being paid for in 22802, along with any intra-op work that would be overlapped betweeen the 2 codes (incision/approach, closure, pain management, etc.). Add-on codes have this reduction automatically built into them, because by nature they will never be the primary code...hence should never be reduced. I did not check your codes for RVU rankings, but the concept is the same regardless of which is primary. I hope this makes sense; I would be happy to discuss further if not.