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Modifiers for CPT code additional codes

  1. #1
    Cool Modifiers for CPT code additioinal codes
    Medical Coding Books
    I am a current student for Medical billing and coding and a question came up in class the other night that I was asked to research for a definitive answer. I was hoping someone out there might be able to help me out. The question is if you have a CPT code with an add on code and you also have a modifier, does the modifier go on the parent code, the add on code or both? Does anyone know the answer and if there is documentation on this where I might find it?

  2. #2
    Have Fun......... and Good Luck........ That question will be getting you to fathom coding........ I'll give you a hint- modifier 51,- and the insurance companies preference.

  3. #3
    Scranton, PA
    Add-on codes are modifier 51 exempt, therefore you should never you that modifier with an add on code. I would think it is going to depend on what the modifier is that you feel you need. Maybe if you post the scenario we can better answer your question.

  4. #4
    Default Scenario
    Split graft 3%, left leg, infant

    CPT codes are 15100 and 15101 X 2.

    Would the LT modifier go on code 15100, 15101 or both?

  5. #5
    Since your in coding school, I wouldn't append any LT modifier. If this were an on the job question, the insurance company and your manager would most likely tell you when to append modifier LT. Take for example: when I use to audit ER some insurance companies would recognise the LT-RT modifiers and some wouldn't recognise it; Sometimes insurance companies required you to use E codes other insurance companies required you to omit E codes. If your teacher is putting you on the spot, append the LT modifier to all the codes. It is appropriate to use this with add-on codes.
    Last edited by 007CPC; 07-09-2008 at 06:13 PM.

  6. Default Modifiers
    Do add on codes requires the use of modifier 50 if they are being doing on multiple vertebraes? I do know that you would not append a modifier 51 on add on codes.

  7. #7
    Smile No
    Carol Buck pg.94 logically explains when to utilize modifiers in appendix A.

    Read Coding edge: issue March: Article by Dr. Zielske Coding Pain Management of the Spine
    Last edited by 007CPC; 04-19-2008 at 09:43 AM.

  8. Default Designated add-on codes;Mod 50; RT/Lt
    Add-on codes or "list separate procedures" are exempt from mod-51 only; other applicable modifiers like; 76,78 can be appended depending on the case.
    Mod-50 can only be used for organs/body parts present on both sides of the axisl(middle) part of the body, i.e.. eyes, extremities, lungs, kidneys...
    RT/LT can be used for organs/extremities with Medicare and Medical, however, it will depend on the Medical Policy on commercial and HMO carriers.
    Good Luck on your certification!

  9. #9
    Lightbulb Notion
    Don't you think students should have to read to find the answers to their assignments!
    Last edited by 007CPC; 04-20-2008 at 08:28 PM.

  10. Default
    I thought you don't you modifiers on add on codes

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