add-on code

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Just an issue I am having. I thought an add on code did not need a modifier, I am probably wrong but here is the scenrio
Dr did one stent 92980
then another 92981 now this ins you do not put RC or LC and have paid the second stent no problem but I have a claim for another ins and they denied the 92981 now my question is are they looking for a 59 modifier? Thanks for any info Nancy
 

Jim Pawloski

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Just an issue I am having. I thought an add on code did not need a modifier, I am probably wrong but here is the scenrio
Dr did one stent 92980
then another 92981 now this ins you do not put RC or LC and have paid the second stent no problem but I have a claim for another ins and they denied the 92981 now my question is are they looking for a 59 modifier? Thanks for any info Nancy
I would use the modifier to define what vascular family the stent was placed, so then you have stated which vessel was stented.
HTH,
Jim Pawloski, CIRCC
 

donnajrichmond

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No, you should not need Modifier-59
You shouldn't, but if you have a contract with this payer, check it. Modifier use is not standardized and can vary from payer to payer. I don't know if it still does, but Louisiana Medicaid used to require 51 modifiers on all surgical codes after the highest value, even those that were add-on or specifically modifier 51 exempt. For example, if we did a 4 vessel carotid/vertebral angiogram, we had to code 36217, 36216-51, 36215-51, 36218-51.
 

ollielooya

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Donna, thank you for your insight. Modifiers seem to be subject to the whim of the payers and not necessarily in line per CPT guidelines. I did not know that modifier 51 exempt codes could be trumped by payer preferences. Thanks for sharing.
---Suzanne E. Byrum CPC
 
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