# Add-on codes and modifers



## Universe33 (Apr 10, 2008)

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


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## Happycoding (Apr 11, 2008)

hai,
  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!!


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## amitjoshi4 (Apr 11, 2008)

Hi

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


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## elenax (Apr 11, 2008)

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.


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## mbort (Apr 11, 2008)

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

64483-rt
64483-59-lt
64484-rt
64484-59-lt

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

http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0742.pdf


Hope this helps


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## amitjoshi4 (Apr 14, 2008)

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:​*[FONT=Arial Narrow,Arial Narrow]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
[/FONT]


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## Universe33 (Apr 14, 2008)

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


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## vruzic (Feb 12, 2009)

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


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## mbort (Feb 12, 2009)

vruzic said:


> so what is the correct coding since we got few anserws?



it really depends on the payor


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## darobi1214 (Nov 6, 2009)

*modifers with add on codes*

Is it written that you cannot add a modifier to an add on code?


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