Wiki Add on Codes and Modifiers


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Today I received a denial from Medicare stating that my add ons were part of the
original surgery.

I called Medicare and the CSR said that the add on's needed a modifier.
At least he was kind enough to confirm that I needed a 58 on each.

I was trained that add on's should not have modifiers.

Are modifiers now required for add ons???

Isn't that denial a bit misleading - saying that they are part of the original
surgery when actually they will be paid if a modifier is applied?
Can you clarify this? What did you originally code when the patient had the initial surgery? If the patient went back to the OR for a second procedure then you'd need the -58 modifier to show it was a staged or related procedure in the post-op period however you can't just use an add on code without having a primary procedure and that procedure definitely needs a modifier if it was done during the post op period.