Wiki Add-on codes vs modifiers

[LaSeille]

When using add-on codes (ie: 49568 for mesh) with the appropriate codes (49560 hernia repair)...does one need to use a modifier (ie: 59 or 51) ?? I thought the whole reason for the code being an "add-on" code was so that it could be billed in addition to the primary code and did NOT need a modifier. According to Medicare (just in 2013 only), we are receiving denials stating that the add-on code needs a modifier because the CCI edits are showing it, and even after speaking with a supervisor, I was informed that if we didn't apply a modifier to the add-on code, it would definitely be denied as per they CCI edit checks. This has NEVER happened before 2013. Anyone have any insight on this??

 

[YStalteri]

add on codes when normally "no modifier needed" BUT.....

You are correct!
Normally no modifier is needed on an "add on code" UNLESS it bundles up against another code within the surgery, global or 10 day post op. Check your NCCI edits it will show if the "add on code" is a catagory 2 code code requiring a modifier. Also check with the carrier to see if they apply the modifier 51 on their end or require you to add it.
Check the Novitas web site under part A or B for recent updates of system malfunctions on their side it shows the various codes their system incorrectly denied "good claims" in error. It lists the current corrections being taken.

Yvonne, RCC, CPC