Modifiers for CPT code additional codes

clwilson813

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Modifiers for CPT code additioinal codes

I am a current student for Medical billing and coding and a question came up in class the other night that I was asked to research for a definitive answer. I was hoping someone out there might be able to help me out. The question is if you have a CPT code with an add on code and you also have a modifier, does the modifier go on the parent code, the add on code or both? Does anyone know the answer and if there is documentation on this where I might find it?
 

007CPC

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Have Fun......... and Good Luck........ That question will be getting you to fathom coding........ I'll give you a hint- modifier 51,- and the insurance companies preference.
 

pattivest

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Add-on codes are modifier 51 exempt, therefore you should never you that modifier with an add on code. I would think it is going to depend on what the modifier is that you feel you need. Maybe if you post the scenario we can better answer your question.
 

clwilson813

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Scenario

Split graft 3%, left leg, infant

CPT codes are 15100 and 15101 X 2.

Would the LT modifier go on code 15100, 15101 or both?
 

007CPC

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Since your in coding school, I wouldn't append any LT modifier. If this were an on the job question, the insurance company and your manager would most likely tell you when to append modifier LT. Take for example: when I use to audit ER some insurance companies would recognise the LT-RT modifiers and some wouldn't recognise it; Sometimes insurance companies required you to use E codes other insurance companies required you to omit E codes. If your teacher is putting you on the spot, append the LT modifier to all the codes. It is appropriate to use this with add-on codes.
 
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tsilas

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Modifiers

Do add on codes requires the use of modifier 50 if they are being doing on multiple vertebraes? I do know that you would not append a modifier 51 on add on codes.
 

007CPC

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No

Carol Buck pg.94 logically explains when to utilize modifiers in appendix A.

Read Coding edge: issue March: Article by Dr. Zielske Coding Pain Management of the Spine
 
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mtsison

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Designated add-on codes;Mod 50; RT/Lt

Add-on codes or "list separate procedures" are exempt from mod-51 only; other applicable modifiers like; 76,78 can be appended depending on the case.
Mod-50 can only be used for organs/body parts present on both sides of the axisl(middle) part of the body, i.e.. eyes, extremities, lungs, kidneys...
RT/LT can be used for organs/extremities with Medicare and Medical, however, it will depend on the Medical Policy on commercial and HMO carriers.
Good Luck on your certification!
 

007CPC

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Notion

Don't you think students should have to read to find the answers to their assignments!
 
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007CPC

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Read Coding edge: issue March: Article- Dr. Zielske Coding pain management of the spine. This is a very good article that gives examples as to when to use a modifier
 

emeskina

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Page 15 (xv) of the CPT Introduction section states the following:

"All Add-on codes found in the CPT codebook are exempt from the multiple procedure concept (see the modifier 51 definition in Appendix A)."

Considering the fact that you cannot use an add-on code by itself, it stands to reason that any modifier that is appended to the primary procedure automatically applies to the add-on code. I believe omitting it, especially in a post op period, or in situations where unbundling issues might be raised, could easily lead to a denial. That's my 2 or 3 cents anyway! Erin
 

007CPC

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it is okay to use level 2 modifiers with add-on

15100-Lt
15101-Lt
15101-Lt
 

moshjl

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Don't you think students should have to read to find the answers to their assignments!
:) I teach ICD-9, CPT coding and an Advanced Billing Concepts class. I encourage my students to use all available recourses in order to find the answer to any coding/billing question they are presented with during class. Considering this is the way they will be researching answers in the "real coding world".
 

007CPC

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I agree

Didn't mean to sound like a "square". The post I was responding from had guidelines copied word-for-word.
 
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Cpt add on codes have modifiers????

Example: The patient if a 67-year-old gentleman with metastatic colon cancer recently operated on for a brain metastasis, now for replacement of a Infuse-A-Port for continued chemotherapy. The left subclavian vein was located with the needle and a guide wire placed . This was confirmed to be in the proper position fluoroscopically. A transverse incision was made just inferior to this and a subcutaneous pocket created just inferior to this. After tunneling, the introducer was placed over the guide wire and the power port line was placed with the introducer and the introducer was peeled away. The tip was placed in the appropriate position under fluoroscopic guidance and the catheter trimmed to the appropriate length and secured to the power port device. The locking mechanism was fully engaged. The port was placed in the subcutaneous pocket and everything sat very nicely fluoroscopically. It was secured to the underlying soft tissue with 2-0 silk stitch. What code should be used for this procedure?
 

samanthab66

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Hello Coders

I am about to graduate from school my date is October 15 I am looking forward to the coding world I have just became a AAPC member so much to learn. I would love to hear from all of you and for some much needed advice of being I new coder and where to began my new career I do want become certified and I am hoping to be able to accomplish before the end of the year

Sincerely,

Samantha Brackin:)
 
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