General Surgery Coding Alert

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When you report "add-on" codes, do you know the special rules that apply? If you can keep just four points in mind, you can gain the best possible reimbursement for your add-on procedures every time. Point 1: Look for the '+' To identify add-on codes in CPT, you should look for a "+" symbol to the left of the code. Also, all add-on codes contain a variation of the phrase "list separately in addition to code for primary procedure" in their CPT descriptors. A typical add-on code listing appears as follows:

+44955 -- Appendectomy; when done for indicated purpose at time of other major procedure (not as a separate procedure) (list separately in addition to code for primary procedure). "The 'plus' designation identifies those codes that the physician performs in addition to other, usually closely related, procedures or services," says Tara L. Conklin, CPC, an instructor for CRN-Institute, a coding and reimbursement institution offering courses in reimbursement, medical billing, outpatient coding certification and inpatient coding certification. "That's why they are called 'add-on' codes: You cannot report them alone, but always 'add them on' to another procedure or service."

Here's an example: A surgeon would never report +48400 (Injection procedure for intraoperative pancreatography [list separately in addition to code for primary procedure]) unless he had to visualize the pancreas for biopsy or excision (for example, 48155, Pancreatectomy, total). Because you would only bill 48400 in addition to another procedure, CPT lists the code as an add-on.

Some E/M services qualify as add-on codes, as well. For instance, you may report prolonged services (such as +99354, Prolonged physician service ...; first hour; and +99355, ... each additional 30 minutes) only in addition to other, primary E/M services (such as an outpatient visit, consult, etc.).

Note: For a complete list of add-on codes, see Appendix D of CPT.

Point 2: Always List With a Primary Procedure You should never list an add-on code without also listing a "primary" procedure. Rather, the add-on code describes additional intraservice work associated with specific primary procedure codes the physician performs during the same operative session or patient encounter, says Anita L. Carter, LPN, CPC, an instructor at A+ Medical Management and Education, a school for billing and coding in Absecon, N.J. In most cases, the primary code(s) for a given add-on code immediately precede the add-on code in the CPT listings. For example, consider the following CPT code sequence:

13131 -- Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; 1.1 cm to 2.5 cm
13132 -- ... 2.6 cm to 7.5 cm
+13133 -- ... each additional 5 cm or less (list separately in addition to code [...]