Wiki Modifiers on add-on codes

LAYANETT

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Hello,

I am currently having this debate with a billing company about add-on code 88341.
The case is for Pathology, and the CPT codes are:
88305 x1
88342 x1
88341 x3
88360 x1

I am pointing out to them that modifier 59 should not be used on add on code 88341, And that it should be reported under 88360 instead but they disagree. 88360 is under the same family of 88342, but it specializes more for lymphoma, which makes it more expensive.

How can I prove this is true? they keep asking me for some type of evidence. i have already told them that my evidence is what i learned in school.

Thank you all for your attention.
 
It sounds like they're looking for a 51 modifier. Modifier 51 indicates multiple procedures. All add-on codes are modifier 51 exempt (see the Add-on Code description on page XV & Appendix A of the CPT manual). Being that add-on codes are essentially modifiers to primary service codes, it would not be appropriate to append a modifier.
 
It sounds like they're looking for a 51 modifier. Modifier 51 indicates multiple procedures. All add-on codes are modifier 51 exempt (see the Add-on Code description on page XV & Appendix A of the CPT manual). Being that add-on codes are essentially modifiers to primary service codes, it would not be appropriate to append a modifier.

Thank you very much for answering my question Lisa, you were very helpful !

Now, Modifier 51 can be used on the list for multiple procedures, but since I work for a HOPD, it is not approved, it gives me a red flag but it does allow 59.
 
If you look in the NCCI tables, there is in fact a code pair edit between 88360 (column 1) and 88341 (column 2) which does mean that a modifier 59 would be required (when supported) in order to allow payment for 88341 when billed together with 88360 if you are billing to a payer that follows NCCI.

I know that it is illogical to need a modifier on an add-on - presumably if the base code is unbundled by use of a modifier, that should carry over to any add-on codes - but NCCI does occasionally place add-on codes in column 2 of their code pairs. I don't know if this is intentional or an error, but either way, there are instances where a modifier 59 is appropriate and necessary for an add-on code.
 
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