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Add-on codes and modifers

  1. Default Add-on codes and modifers
    Medical Coding Books
    Hola!! I work for an ASC and I am the only coder here!!! which I like. Anyways...the question came about using the add on codes in reference to pain management.

    I code a lumbar transforaminal steriod injection with four levels bilateral- 64483-50, 64484-50, 64484-50, 64484-50. Should I append mod 59? Medicare isn't paying for the additional levels and my manager thinks it's because they want the 59- for multiple procedures, which is unclear to me. Can someone shedd some light on this topic? Thank you so much, Mela

  2. Default Add-on codes and modifers
    I had coded for ASC long before and i would code the scenario which you have states as below:
    64483- 50
    64484 x 3- 50.

    i would convert units to times three. but if that will not be allowed ,no way we have to differentiate using modifiers only, say 59. so the other way of coding will be as follows.
    64483- 50
    64484- 50
    64484- 50, 59
    64484 -50, 59.

    hope this will help to some extent. have a great day!!

  3. Arrow Add-on codes and modifers

    Yes i have been a regular ASC coder for pain management. The correct way to code is :
    64483 50
    64484 50
    64484 5950
    64484 5950.

    If fluro is used we code 77003 TC per region. So if L3-L4, L4-L5,L5-S1 is there , we will put fluro twice ; one for lumbar region and other for sacrum region.

    Hope this will benefit.

    Thank You
    Amit Joshi MSc,CPC,CPC-H

  4. #4
    Thumbs up
    I agree with Amit; Medicare will pay for the multiple levels is you add the 59 Modifier. I also work for an ASC and that is how I get them paid.

  5. #5
    I break mine out to separate line items and use the 59. I do not use the 50 modifier on the pain management procedures


    Since the 77003-TC is a payment indicator N1, I document, but do not send to Medicare.

    Here is a MedLearnMatters article--see page 11

    Hope this helps

  6. Arrow
    I also agree on this. My company's Medical Billing team do in this manner only but as a Coder, I will have to follow the coding guidelines.if we look this on page 11

    Billing Bilateral Procedures:
    Bilateral procedures should be reported as a single unit on two separate lines or with "2" in the units field on one line, in order for both procedures to be paid. While use of the -50 modifier is not prohibited according to Medicare billing instructions, the modifier is not recognized for payment purposes and if used, may result in incorrect payment to ASCs. The multiple procedure reduction of 50 percent will apply to all bilateral procedures subject to multiple procedure discounting.

    The use of 50 is correct but not for payment methods. Coders task is to provide best codes for maximum reimbursement in accordance with guidelines. How to take out the payment using these codes is the the task of a Biller.

    We follow this approach and are successful also till time.

    Thank You
    Amit Joshi MSc,CPC,CPC-H

  7. Wink
    Thank you everyone for your input!!! Yes this is what I needed!

  8. Default
    so what is the correct coding since we got few anserws?

  9. #9
    Quote Originally Posted by vruzic View Post
    so what is the correct coding since we got few anserws?
    it really depends on the payor

  10. Default modifers with add on codes
    Is it written that you cannot add a modifier to an add on code?

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