Add on codes with BCBS

[Blackhorse]

Does anybody know if BCBS pays add on codes in ASC, such as 64494, 64634, 64636? I was told to not bill add on codes in ASC because they are bundled with the primary CPT? However I was also told it depends on the contract.

 

[thomas7331]

I think you were given incorrect information if you were told not to bill these. While it's true that many payers do not make a separate payment to facilities for add-on codes, that is because the contracted payment for those codes is included in the case rate which is paid on the base procedure. It does not mean that you should leave those codes off your bill. The claim should accurately report what was done and if the contract does not reimburse that charge, then it should be adjusted after the claim is processed.

You should code all of the procedures that were performed for all of your payers - it is incorrect coding to fail to report codes based solely on an expectation of whether or not those codes are going to be paid.