Neurosurgery Coding Alert

Always appeal -multiple-procedure reductions- with add-ons

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.

--Look for the -+-

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:

- 22520--Percutaneous vertebroplasty, one vertebral body, unilateral or bilateral injection; thoracic
- 22521--lumbar
- +22522--each additional thoracic or lumbar vertebral body (list separately in addition to code for primary procedure).

In this case, the add-on code (22522) follows its related primary procedure codes (22520 and 22521). To drive home the point, CPT instructs, -Use 22522 in conjunction with 22520, 22521 as appropriate.-

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, CPT states that you should report +62160 (Neuroendoscopy, intracranial, for placement or replacement of ventricular catheter and attachment to shunt system or external drainage [list separately in addition to code for primary procedure]) with 61107, 61210, 62220, 62223, 62225 and 62230.

Some E/M services qualify for add-on codes, Kibat says. 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.

Hint: For a complete list of add-on codes, consult CPT's Appendix D.
 
--Stay Away From Modifier 51

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.-

--Be Sure You Are Paid in Full

Always check your explanation of benefits carefully 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 surgeon 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.- Any further reduction in payment is therefore 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.