Oncology & Hematology Coding Alert

Try this strategy to get full ethical reimbursement from payers

If you don't think -add-on- codes are particularly important and leave them off of your claims, you-re letting hard-earned dollars slip away. Stop the dollar drain with these pointers.
 
Term: CPT uses an -add-on- designation to identify services or procedures that always occur -in addition to- other services or procedures. You would never report an add-on code alone because it must accompany a designated -parent- code. Add-on codes can include the full range of CPT procedures, from E/M services to surgical procedures.

Spot Add-On Codes by the -+-

 To identify add-on codes in the CPT manual, you should look for a -+- symbol to the left of the code. Also, 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:

 - +96411 -- Chemotherapy administration; intravenous, push technique, each additional substance/drug (list separately in addition to code for primary procedure).

 Rationale: You can't administer an -additional substance- without having an initial substance, so CPT lists the code for the additional substance as an add-on.
 
Some E/M services qualify as add-on codes, as well. For instance, prolonged service codes (such as +99354, Prolonged physician service ...; first hour; and +99355, ... each additional 30 minutes) are add-on codes, which means you must tag them to other E/M services, says  Catherine Brink, CMM, CPC, president of Healthcare Resource Management of Spring Lake, N.J.
 
Tip: For a complete list of add-on codes, consult CPT Appendix D.

Don't Commit This Primary Procedure Code Crime

You should never list an add-on code without also listing a code for a -primary- procedure. Rather, the add-
on code describes additional intraservice work or more involved work (as in the example below) associated with specific primary procedures the physician performs during the same patient encounter.
 
In most cases, the primary code(s) for a given add-on code immediately precede it in the CPT listings. For example, consider the following CPT code sequence:
 
- 96420 -- Chemotherapy administration, intraarterial; push technique

- 96422 -- - infusion technique, up to one hour

- +96423 -- - infusion technique, each additional hour.

 In this case, the add-on code (96423) follows the related primary procedure code (96422).
 
And CPT includes an instructional note, -Use 96423 in conjunction with 96422.-

Be on the lookout for exceptions: CPT does not list all add-on codes near their primary procedure codes. In most cases, when CPT does not list the add-on code and primary codes together, the manual provides instructions on which codes should accompany the add-on code.

Example: CPT states that you should report +90767 (Intravenous infusion, for therapy, prophylaxis, or diagnosis [specify substance or drug]; additional sequential infusion, up to 1 hour) with infusion codes 90765, 90774, 96409, and 96413 -- which appear in different areas of the CPT Medicine section.

Helpful: Use 90767 to describe an infusion of a different drug during the same encounter as the primary infusion -- which may not be the first administered. You should report 90765-90766 (Intravenous infusion, for therapy, prophylaxis, or diagnosis ...) for the infusion that represents the key reason for the encounter, regardless of the order that the infusions occur, says Rhonda Buckholtz, CPC, practice administrator at Wolf Creek Medical Associates in Oil City, Pa. Be careful: Staff may administer the drug that counts as the initial infusion in the second or third IV bag.

Subtract Modifier 51 From Add-On Claim

 You should never append modifier 51 (Multiple procedures) to a designated add-on code. Modifier 51 indicates a procedure or service that is usually performed independently but, in the cited case, is performed at the same time as another procedure.

Because add-on codes are defined as additional services or procedures, modifier 51 is redundant and, for some payers, can even harm your reimbursement.

Combat Low Payments -- Here's How

 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.

The amounts the fee schedule assigns to add-on codes reflect their status as -additional procedures.- Any further reduction in reimbursement below the fee-schedule amount represents an unreasonable payment devaluation.

Fight reductions: If you find a payer reducing the fees for your add-on codes, be sure to appeal the claims. Cite AMA guidelines from the CPT manual's -Introduction,- which clearly state, -All add-on codes found in the CPT book are exempt from the multiple- procedure concept.-