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Add on codes-looking for

  1. #1
    Default Add on codes-looking for
    Medical Coding Books
    I am looking for a little feed back for the add on codes that we bill out. IE 64623, 64627 & 63035.

    If there is more then one bilateral add on code it is denied out. I have found that there is a ton of literature on the usage of modifier 59 not to be used for the add on codes.

    Can any one tell me how to bill out and get paid for 3 bilateral CPT codes for Injections or Radiofrequency. It would be greatly appreciated.

    Thank you for all the Help

  2. #2
    Columbia, MO
    you cannot use 51 on add on but you can certainly use the 59, I do it all the time and no problems. The problems I have fixed in practices with these same codes are when they have been using units greater than 1 on the add on codes and the payer responses are all over the place, I replace the units with 1 and submit multiple lines with the 59 modifier, across the board every payer pays and the pay is corret.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    I posted a questions yesterday and I was wondering if you might be able to assist me in one other questions about the modifier 59 to add on codes.

    My questions is since the description of the modifier 59 states to use it when it is a separate procedure on a different anatomic site. Since the Dr would be doing it on all the lumbar region but in different areas like L3, L4, L5 and there is not a DX code to indicate the L3, L4, & L5 it would still be appropriate to use the modifier 59?

    I need to dispute this with my boss as he is stating that it cannot be used since it is the same anatomic site.

    I am new to coding and I am about to take my test. Sometimes I feel like there is so much I don't know.

    Thank you again for all your help.

  4. #4
    An issue that you will encounter is bilateral procedures on mulitple levels such as

    721.3 Lumbar Spondylosis/facet arthropathy

    64622-50 L3 paravertebral facet joint nerve
    64623-50 L4
    64623-50 L5

    If you would try to use 64623 quantity 2 and also add 50 modifier it could potentially deny. In the previous response that you received, they are stating by placing it on separate lines and billing as such
    64623-50 ---add additional note on claim
    64623-50 59

    you are indicating that three separate levels were treated bilaterally. There can be a issue with trying to alternatively bill as such

    64623 x 4 additional note in box 19--- 2 addl levels performed BILATERALLY

    A bilateral procedure processes at 150 percent of the allowable and in order for it process correctly by the carrier's processing software, like noted above bilateral procedures with 50 modifier for add on codes can not typically have a quantity greater than one. And there can be a concern of using quantity 4 for two bilateral procedures on an add on code versus placing on separate lines so that they can each be processed as 150 percent of the allowable. Although 59 modifier is typically used for a code pair identified by NCCI, in this case it is to denote that a separate level was performed and assist the carrier's software from creating a duplicate denial when it does not see the 59 modifier. Will have to monitor the payments and determine that this works for the carrier and it is processed correctly.

  5. #5
    Thank you for all the help

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