Wiki Add-Ons Question

[SeriousHistorian]

Am studying for the CPC exam and need clarification on the following:

If an + (Add-on sign) follows a main entry, does this mean the listed Add-on code covers, for instance, more than one digit, etc. in the same operation/service by the (same) physician.

The CPT states, and I understand, too, the + is exempt from modifer 51 (multiples), but I am finding this a quagmire. In an AAPC article on Add-ons, people are arguing that modifiers can be used. I don't read the CPT Guideline that way, so I figure I am missing something important somewhere.

For instance, and this is only my own example, if I code 26125 (the Add-On), is this the only code that would be used in conjunction with code 26123? Or, would I take the main code 26100 (Arthrotomy with biopsy, carpometacarpal joint, each), then list code 26123 (Fasciectomy . . . .), then the Add-On?

What is confusing to me is, if this was a physician removing a finger, for instance, and finds he has to remove one or more "digits" as a connective problem, would he still use only one Add-on code (same operation, same problem)? So, too, what does "list separately" mean?

Would appreciate input here. Make it simple, please?

Thank you!

 

[lisigirl]

I'm not sure if I understand the question completely but maybe this will help. An add-on code can only be billed with the primary procedure code. In this case, 26123 is the primary code and it includes doing a fasiectomy on one digit. If the surgeon does this on more than one digit you would also bill the add-on code of 26125 for each additional digit (that is what list separately means - you bill for each add'l digit separately).

for example, a fasiectomy of 3 digits would be billed as: 26123, 26125, 26125

(You may need to add a modifier -59 to the 2nd 26125 to indicate this is not a duplicate charge. I don't think you should have to add the -59 but I think we've experienced denials when we don't use the modifier).

Hope that helps.

Lisi, CPC

 

[SeriousHistorian]

I'm not sure if I understand the question completely but maybe this will help. An add-on code can only be billed with the primary procedure code. In this case, 26123 is the primary code and it includes doing a fasiectomy on one digit. If the surgeon does this on more than one digit you would also bill the add-on code of 26125 for each additional digit (that is what list separately means - you bill for each add'l digit separately).

for example, a fasiectomy of 3 digits would be billed as: 26123, 26125, 26125

(You may need to add a modifier -59 to the 2nd 26125 to indicate this is not a duplicate charge. I don't think you should have to add the -59 but I think we've experienced denials when we don't use the modifier).

Hope that helps.

Lisi, CPC

Lisi, many thanks for your response. It was exactly what I needed to understand! It was confusing to me.

Again, thank you!