Use your add-on code savvy to net up to $258 in additional reimbursement. Look for the '+' Symbol There's an easy way to tell if a CPT code is designated as an add-on code. Just look for a plus sign (+) symbol to the left of the code in your CPT manual. Another helpful hint is that in their code descriptors all add-on codes contain a variation of the phrase "List separately in addition to code for primary procedure." "You will also find a listing of the CPT code range in which that add-on code may be used in addition with," says Nicole Martin, CPC, owner of Innovative Coding Analysis in Coplay, Penn. That listing follows the add-on code descriptor in the CPT manual. Example: • +57267 -- Insertion of mesh or other prosthesis for repair of pelvic floor defect, each site (anterior, posterior compartment), vaginal approach (List separately in addition to code for primary procedure). Pointer: Tip: Always List "Add-Ons" With a Primary Procedure As noted in the previous article, you should never report an add-on code without also listing a "primary" procedure code. Here's why: "In most cases, add-on codes represent the 'above and beyond' that a provider might do along with the usual services," says Denae M. Merrill, CPC, CEMC, HCC coding specialist for The Coding Source and owner of Merrill Medical Management. Example: 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: • 51728 -- Complex cystometrogram (ie, calibrated electronic equipment); with voiding pressure studies (ie, bladder voiding pressure), any technique • 51729 -- ... with voiding pressure studies (ie, bladder voiding pressure) and urethral pressure profile studies (ie, urethral closure pressure profile),any technique • +51797 -- Voiding pressure studies, intra-abdominal (ie, rectal, gastric, intraperitoneal) (List separately in addition to code for primary procedure). In this case, the add-on code (+51797) follows the primary procedure codes (51728 and 51729) to which it is related, even though the code is not in numerical order in the CPT manual. Plus, CPT instructs, "Use 51797 in conjunction with codes 51728, 51729." Caveat: Skip Modifier 51 With Add-on Codes You should never append modifier 51 (Multiple procedures) to a designated add-on code, Merrill says. Modifier 51 indicates a procedure or service that can be performed independently but, in the cited case, is performed at the same time as another procedure. CPT stresses this point by stating, "All add-on codes found in the CPT book are exempt from the multiple procedure concept." Reason: Check your payments: Always check your explanation of benefits (EOB) 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. For example, if you report +57267 for a mesh insertion procedure, you should receive the full $258 fee for that code (7.16 RVUs based on the 2010 Medicare Physician Fee Schedule and the conversion factor [CF] of 36.0846). "Add-on codes should never be reduced for multiple procedure discounts," Martin warns. "They should always be paid at 100 percent of the contract amount" unless you have entered into an insurance contract, such as a hospital/facility insurance contract that specifies different reimbursement. 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 as additional procedures exempt from modifier 51 rules.