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Wiki add-on codes
- Thread starter ljhardage
- Start date
Barbiejean
Contributor
Help with add on codes.....
I know the answer to this question....but I'm needing physical "proof" for a stubborn insurance company that has all of a sudden decided that they need modifiers for add on codes.
example..... I've got a 17311 & 17312 that were billed in a 14060 global period. Had a brain cloud that day and didn't add the -79 modifiers to both the 17311 & the repair code. Sent it as a corrected claim back to the insurance company via fax (they don't take corrected claims electronically). The 17311 & repair code were both paid, but they continue to deny 17312 saying it is part of the global. I've appealed this at least twice, but they have upheld their decision. NOW I have to get the pt involved (he has to "allow me" to appeal on his behalf). They are wanting "proof" that the add on codes are exempt from modifiers. In the CPT book it says it is -51 exempt, but that's it. WE all know they are exempt.....but I need to prove it to the carrier.
Any help is greatly appreciated.
Thanks.....
I know the answer to this question....but I'm needing physical "proof" for a stubborn insurance company that has all of a sudden decided that they need modifiers for add on codes.
example..... I've got a 17311 & 17312 that were billed in a 14060 global period. Had a brain cloud that day and didn't add the -79 modifiers to both the 17311 & the repair code. Sent it as a corrected claim back to the insurance company via fax (they don't take corrected claims electronically). The 17311 & repair code were both paid, but they continue to deny 17312 saying it is part of the global. I've appealed this at least twice, but they have upheld their decision. NOW I have to get the pt involved (he has to "allow me" to appeal on his behalf). They are wanting "proof" that the add on codes are exempt from modifiers. In the CPT book it says it is -51 exempt, but that's it. WE all know they are exempt.....but I need to prove it to the carrier.
Any help is greatly appreciated.
Thanks.....
Grintwig
Expert
When the new debridement codes came out a few years ago I got an education in this regard.
We had a patient with a LARGE abscess and our doc debrided it to the tune of 160 square centimeters. Medicare paid the original debridement code and denied all of the add on codes for the additional 140 sq cm. After a few calls to Medicare I finally decided that even though you "should not" have to add a modifier to an add-on code I would add a -59 to all of the remaining codes. Guess what? They paid them all!
For some reason Medicare requires the -59 on the codes for the add-ons for the debridements. As far as I know it is not illegal to add them as they are done in addition to the base code and since the base code is only 20 sq cm anything over that could be considered distinctly separate. I went back and added the -59 to all of the other instances of that code combination that had been denied and got payment on them all.
I have never really gotten a straight answer for why Medicare wants this code set done this way but in several seminars since I have been advised that it is fine to add the -59.
We had a patient with a LARGE abscess and our doc debrided it to the tune of 160 square centimeters. Medicare paid the original debridement code and denied all of the add on codes for the additional 140 sq cm. After a few calls to Medicare I finally decided that even though you "should not" have to add a modifier to an add-on code I would add a -59 to all of the remaining codes. Guess what? They paid them all!
For some reason Medicare requires the -59 on the codes for the add-ons for the debridements. As far as I know it is not illegal to add them as they are done in addition to the base code and since the base code is only 20 sq cm anything over that could be considered distinctly separate. I went back and added the -59 to all of the other instances of that code combination that had been denied and got payment on them all.
I have never really gotten a straight answer for why Medicare wants this code set done this way but in several seminars since I have been advised that it is fine to add the -59.