Wiki multiple surgical reductions and add-on codes

[md1m03]

I am looking for some help in determining what the industry standard is for processing claims with multiple procedures and multiple add-on codes.

How are you seeing the insurance companies allowing benefits for secondary procedures with add-on codes? Are they reducing the secondary procedure and add-on procedure by 50% or only the secondary procedure and the add-on allowed at 100%?

Example:

61512 - primary procedure
+61781 - add-on to primary
14301 - secondary procedure
+14302 - add-on to secondary procedure
15120 - secondary procedure
+15121 - add-on to secondary procedure

Any assistance you can provide will be greatly appreciated.

Donna Forsell

 

[mmpratt]

Hi Donna,
I am seeing secondary procedures reduced by 50% and add-on codes being paid at what the payer determines to be its allowed. Some payers reduce the secondary by 50% and subsequent procedures (not add-ons) by even more.

I'm finding that I have to look carefully at our contracts and/or payer reimbursement rules on web sites to know what to expect. I haven't ever billed for more than one add-on code so can't help you there.

Marilyn

 

[mitchellde]

multiple procedures reduce when performed in the same procedural session. This is due to the prep that is a part of the reimbursement is not repeated when all procedures are performed in the same session. Ad on codes are not reduce since it is mandatory that they be performed with another procedure, therefore they do not include the prep as a part of the reimbursement.