Neurology & Pain Management Coding Alert

Reporting "add-on" codes is a snap, as long as you check three items before you submit your claims for payment, experts say. But you-ll also want to check a fourth item after the reimbursement check arrives.

To identify add-on codes in CPT, you should look for a "+" symbol to the left of the code. In addition, add-on codes- descriptors often state, "List separately in addition to code for primary procedure," or offer similar instructions.

"The -plus- designation identifies those codes that the physician performs in addition to other, usually closely related, procedures or services," says Kate Kibat, CPC, compliance educator at the University of Washington Physicians in Seattle.

Always List Add-Ons With a Primary Procedure

You should never list an add-on code without also listing a "primary" procedure. The add-on code cannot stand alone but instead describes additional intraservice work associated with specific primary procedures the physician performs during the same session or patient encounter, say Kibat and Susan Allen, MBA, CPC, CCS-P, with Compliance Coder in St. Petersburg, Fla.

In most cases, the primary codes for a given add-on code immediately precede the add-on code in the CPT listings. For example, consider this code sequence:

In this case, the add-on code (95962) follows its related primary procedure code (95961). To drive home the point, CPT further instructs, "Use 95962 in conjunction with 95961."

Look out for exceptions: CPT does not list all add-on codes with their primary procedure codes. In most cases when CPT doesn't list the add-on code and primary codes together, it provides instructions regarding which codes should accompany the add-on code.

For example, some E/M services qualify for add-on codes, Kibat says.

For instance, you may report prolonged services (such as +99354, Prolonged physician service in the office or other outpatient setting requiring direct [face-to-face] patient contact beyond the usual service [e.g., prolonged care and treatment of an acute asthmatic patient in an outpatient setting]; first hour [list separately in addition to code for office or other outpatient evaluation and management service]; and +99355, ... each additional 30 minutes [list separately in addition to code for prolonged physician service]) only in addition to other, primary E/M services your neurologist provided.

Hint: For a complete list of add-on codes, consult CPT's Appendix D.

You should never append modifier 51 (Multiple procedures) to a designated add-on code, Allen says.

"Multiple-procedure rules do not apply to add-on procedures; therefore, appending modifier 51 may reduce reimbursement unnecessarily," she adds.

CPT confirms these guidelines by stating, "All add-on codes found in the CPT book are exempt from the multiple-procedure concept."

Always carefully check your explanation of benefits for claims with add-on codes to be sure the payer reimburses you the entire fee schedule rate for the billed procedures or services.

Often, when a physician performs multiple procedures, the carrier will reduce payment for the second and subsequent procedures because the first procedure's cost already covers the presurgery evaluation, preparation and postsurgical care. But this logic does not apply to add-on procedures.

The fee schedule amounts assigned to add-on codes already reflect their status as "additional procedures." Therefore, any further reduction in payment is inappropriate.

Fight reductions: If you find a payer reducing the fees for your add-on codes, be sure to appeal the claims. Cite the definition of add-on codes (explained in CPT's "Introduction" portion) as additional procedures exempt from modifier 51 rules.