Add on codes & modifiers

agongora1

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Pearland, TX
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We billed primary code (99291-25) with add-on code (99292) along with 36620. The claim denied. Stating that procedure code 99292 needed an add-on code.

Now, first I wanted to append a 59 modifier to procedure code 36620. The insurance company is stating that a modifier needed to be appended to procedure 99292. It was my understanding that you never add a modifier to an add-on (according to the CPT book).

Can someone please help clear this up for me? I would greatly appreciate it.
 

Kiana

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Tucson
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99292 is the add-on E&M to 99291 the additional 30 minutes that went above and beyond time alloted for the 99291 you can append -25 as you same day procedure is significant and seperate from your procedure. -59 would not work w/ your procedure because you only did (1) procedure.
 
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4,466
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Milwaukee WI
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Mod 25 on BOTH 99291 and 99292

You'd add the -25 modifier to BOTH 99291 and 99292.
This tells the carrier that the E/M service was significantly separate from the procedure(s) performed.

F Tessa Bartels, CPC, CPC-E/M
 

dimichele1

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Williamsport, PA
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Coders in my office also say a 25 modifier can't be appended to an add-on code. I don't agree. While I understand the redundancy of a modifier, in the case of time-based codes, I think the add-on needs a modifier to distinguish as separate from the procedure performed. Just because the first 30 minutes was a separately identifiable procedure does not mean all subsequent time is.
 

KellyLR

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La Plata, MD
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-25 Modifier and 99291 99292

Critical care services are not typical postoperative care. Preop and postop critical care may be paid in addition to a global fee if the patient is critical and in need of constant physician supervision. -25 can be used if the treatment was unrelated to the critical care. Payors will specify this in their guidelines how they want the documentation and proper coding to be reported. CMS requires two reporting services; ICD-9-CM code range of 800.0-959.9 (except 930-939) which will clearly demonstrate thst the critical care was unrelated will suffice. I would look up the payor rules specific to -25. Payors are a trip when it comes to -25. it seems like they like to penalize the doc for doing two things on the same day rather than the payor wanting them done separately. Go figure. Hope it helped
 
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