Wiki Add on codes and 59 modifier

[AlwaysLearningCoder]

I know that add-on codes are mod 51 exempt but we are having problems getting them paid without a mod 59 also. Now I need some documentation as to whether the add-on codes can have mod 59 added or if they follow the modifiers that are linked to the primary code. Biggest insurances with this issue are BCBS and UHC and Aenta..
Please let me know what you think or where I could find something in writing regarding this issue.
ex: 63047-59/51 and 63048
thank you

 

[mitchellde]

why do you have a 59/51 on the 63047?

 

[AlwaysLearningCoder]

I do apologize, it was an incomplete message.. typing in a hurry
we are billing the 63047/63048 with 22612, 22614, 22630, 22849, 63047, 63048. Decompression is also performed during the surgery..

 

[mhanson1]

I pulled up the NCCI edits in the CMS website. I see that 63047 is bundled with 22630. 63048 is not bundled with any of the codes provided. So, no modifier would be required for 63048. Hope that helps.
Michelle Hanson, CPC

 

[RebeccaWoodward*]

I do apologize, it was an incomplete message.. typing in a hurry
we are billing the 63047/63048 with 22612, 22614, 22630, 22849, 63047, 63048. Decompression is also performed during the surgery..

63047/48 can be reported with 22630, when, in addition to removing the disk and preparing the vertebral endplate, the surgeon removes posterior osteophytes and decompresses the spinal cord or nerve roots, which requires work in excess of that normally performed when doing a PLIF.