Wiki Billing primary codes/add-on codes on separate claims for same date of service

[dratner@athenahealth.com]

Hello-

If one provider performed the primary procedure, and a different provider on the same date of service performed the add-on procedure, is it possible to bill these codes on two claims under each individual provider's credentials within the same facility?

For example: Dr.A performs primary code 93458 and then Dr.B performs 93571 add-on code on the same date of service in the same facility. Could these codes be billed on two separate claims?


Thank you

 

[Pathos]

CMS says no:

"An add-on code is a HCPCS/CPT code that describes a service that, with one exception (see CR7501 for details), is always performed in conjunction with another primary service. An add-on code with one exception is eligible for payment only if it is reported with an appropriate primary procedure performed by the same practitioner. An add-on code with one exception is never eligible for payment if it is the only procedure reported by a practitioner."

In order to bill an add-on code, the provider must perform both the primary code and the add-on code. The exception above refers to a Critical Care situation.

AMA CPT 2018 Standard book:

"Add-on codes are always performed in addition to the primary service or procedure and must never be reported as a stand-alone code. All add-on codes in the CPT code set are exempt from the multiple procedure concept (modifier 51)."


Hope that helps!

 

[1formissy]

I agree with Pathos. You can only do this for critical care