Wiki Using 59 to an add on code?

[fdas tberat5aew]

With the recent code changes to spinal surgery, the new codes 22853, 22854, 22859 indicate that the anterior instrumentation is included in these codes and you should not use the segmental spinal instrumentation codes set in addition to the above codes. However, I have read an article that was put out by the North American Spine Society that states "if separate anterior instrumentation is inserted, it is appropriate to code for both the interbody device and the anterior instrumentation with the appropriate modifier (-59)", (Spineline, 2017).

I was always under the impression that you could not add a modifier to an add on code. Is this correct, or can you use a modifier to an add on code? I look forward to a response. Thank you.

References

Blassier, R. D., M.D., Cheng, J., M.D., Lahey, D., RNFA, Mitchell, W., M.D., & Swartz, K., M.D. (2017, April). Coding for Spinal Interbody Biomechanical Cages and Devices. doi:www.SPINELINE-DIGITAL.ORG

 

[amandamkcj]

Yes you may append modifier 59 to an add on code. In this case it would go on the 2284X instrumentation code. Rule of thumb is documentation to ensure that the instrumentation is not integral with the interbody and if it is truly a stand alone device than you would capture 2284X-59 and 2285X.

While it isn't typical to append modifiers on add-on codes you definitely are allowed to do so. If you have encoder or another coding software it will show per CPT what modifiers are allowed.

 

[sarab86]

There is a new CMS Edit for 2017 that bundles 22845 to 22853/22854/22859 because when Anterior instrumentation is used with an Interbody device, you have to show that you used a separate plate and it was not integral anchoring of the cage. You will have to bill 22845 with modifier 59. Be sure that it is clear in the OP note and with your provider that this is a separate plate. Example of Integral Anchoring would be like a Prevail cage where the anchoring is built into the cage.