Wiki Use of Modifiers with Add On Codes

[rturner96]

We recently changed to a new billing company whose practice is to add modifier 59 to our surgical add on codes. It's my understanding that modifiers are not necessary for add on codes because these codes 1)cannot be billed without a primary code and 2) the fee is already discounted since it is a secondary procedure.

Examples of add on codes in question are 63048, 22840, 22851.

Appreciate input.

 

[ahonkomp]

Modifiers should not be used on add on codes....That is what I have always learned/been told......

 

[JEYCPC]

Modifiers definitely should not be amended to add on codes. I would be concerned.

 

[Anitha Lingala]

I agree, no modifiers on add-ons.

 

[Anitha Lingala]

Unless it is like a CPT 99292 (EM code with a 0-10 global procedure code) - 25 modifier can be used.

 

[emcee101]

Even more alarming is that your billing company is adding modiiers to ANYTHING! They are being paid to bill what you send to them, correct? If they are coding as well as billing then that is a diferent story (and you can disregard my diatribe below) but if they are only doing your billing then they should not adjust or modify your coding in ANY way.

Billing companies can and will alter your coding to try and increase reimbursement because they are paid based on a percentage of the reimbursement you receive and it is in their financial benefit to unblundle, upcode, etc. as many procedures as possible to increase your reimbursement since this also increases their payment by default. They have no real "skin in the game" to adhere to ethical practices because you are the one that is liable from a legal/compliance perspective when CMS or the insurance companies determine that you were reimbursed improperly due to inappropriate coding and then take back the reimbursement, or worse.

You should audit your coding against their billing on a regular basis and develop a corrective action plan and possibly even a penalty system if you start to find discrepancies in what you send them vs. what they are billing. This is a fairly quick process that can be done by matching your coding against EOB and looking for any discrepancies.

 

[ollielooya]

Thanks emcee for your so-called "diatribe". I work for a billing agency and my coding background/certification serves well in making sure that proper modifiers are used. I keep a wary eye on those claims that are billed with modifier 59 and the new subsets amongst the myriad of many others and alert the doctors to whether they are properly added or missing. We wait to receive permission to make the changes, because ultimately they are the ones responsibile for their code/modifier choices. I hope your reply catches the attention of many. Your comments are appreciated.

 

[JCaillouet]

emcee: you're appealing to probability. I work in a third party myself and I am waiting client approval for even remotely starting a concerning trend on how to fix. I ask, I seek, I try to get an understanding.

@OP you would do well to really request an audit of the claims and WHY they feel it's ok to do that.