Results 1 to 3 of 3

Add-Ons Question

  1. #1
    Location
    AZ East Valley-Kachina Coders
    Posts
    17
    Default Add-Ons Question
    Exam Training Packages
    Am studying for the CPC exam and need clarification on the following:

    If an + (Add-on sign) follows a main entry, does this mean the listed Add-on code covers, for instance, more than one digit, etc. in the same operation/service by the (same) physician.

    The CPT states, and I understand, too, the + is exempt from modifer 51 (multiples), but I am finding this a quagmire. In an AAPC article on Add-ons, people are arguing that modifiers can be used. I don't read the CPT Guideline that way, so I figure I am missing something important somewhere.

    For instance, and this is only my own example, if I code 26125 (the Add-On), is this the only code that would be used in conjunction with code 26123? Or, would I take the main code 26100 (Arthrotomy with biopsy, carpometacarpal joint, each), then list code 26123 (Fasciectomy . . . .), then the Add-On?

    What is confusing to me is, if this was a physician removing a finger, for instance, and finds he has to remove one or more "digits" as a connective problem, would he still use only one Add-on code (same operation, same problem)? So, too, what does "list separately" mean?

    Would appreciate input here. Make it simple, please?

    Thank you!

  2. Default
    I'm not sure if I understand the question completely but maybe this will help. An add-on code can only be billed with the primary procedure code. In this case, 26123 is the primary code and it includes doing a fasiectomy on one digit. If the surgeon does this on more than one digit you would also bill the add-on code of 26125 for each additional digit (that is what list separately means - you bill for each add'l digit separately).

    for example, a fasiectomy of 3 digits would be billed as: 26123, 26125, 26125

    (You may need to add a modifier -59 to the 2nd 26125 to indicate this is not a duplicate charge. I don't think you should have to add the -59 but I think we've experienced denials when we don't use the modifier).

    Hope that helps.

    Lisi, CPC

  3. #3
    Location
    AZ East Valley-Kachina Coders
    Posts
    17
    Default
    Quote Originally Posted by lisigirl View Post
    I'm not sure if I understand the question completely but maybe this will help. An add-on code can only be billed with the primary procedure code. In this case, 26123 is the primary code and it includes doing a fasiectomy on one digit. If the surgeon does this on more than one digit you would also bill the add-on code of 26125 for each additional digit (that is what list separately means - you bill for each add'l digit separately).

    for example, a fasiectomy of 3 digits would be billed as: 26123, 26125, 26125

    (You may need to add a modifier -59 to the 2nd 26125 to indicate this is not a duplicate charge. I don't think you should have to add the -59 but I think we've experienced denials when we don't use the modifier).

    Hope that helps.

    Lisi, CPC
    Lisi, many thanks for your response. It was exactly what I needed to understand! It was confusing to me.

    Again, thank you!

Similar Threads

  1. Help with Tissue Transfer add-ons!!
    By pmogel in forum Plastic Surgery
    Replies: 0
    Last Post: 04-10-2015, 06:53 PM
  2. confused about add-ons for branches
    By freda in forum Cardiology
    Replies: 1
    Last Post: 04-24-2013, 12:21 PM
  3. denails for debridement add ons 11046
    By coder1 in forum Billing/Reimbursement
    Replies: 12
    Last Post: 05-16-2011, 03:56 PM
  4. Add on question
    By jkh429 in forum Billing/Reimbursement
    Replies: 2
    Last Post: 09-20-2010, 04:06 PM
  5. Add-Ons Question
    By SeriousHistorian in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 01-31-2010, 02:19 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.