Killer tips for Using Add on CPT Codes

What are Add on Codes?


Add on CPT codes are procedure performed in conjunction with another primary procedure. The add on codes are not allowed to report without their primary procedure or CPT code. Add-on codes cannot stand alone as separately reportable services. Add on codes are mostly define by their primary procedures. Add on codes includes surgery CPT codes, imaging guidance CPT codes, Supervision and interpretation codes etc. If you understand add on codes and how to use them, it will help you in clearing coding certification exams.


Killer tips for Using Add on CPT Codes

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Never Use Add on Codes as Primary


Add on codes should always be coded with their primary procedure. Add on codes have “+” sign in front of them, which denotes it an add on code. These codes are always used as secondary to give more information about the primary procedure. For example, in breast cyst aspiration we have two CPT codes 19000 and +19001. Here, CPT code +19001 is an add on code used when more than one breast cyst is aspiration. Hence, when two breast cysts are aspirated we code primary procedure as 19000 CPT codes and each additional breast cyst aspiration is coded with CPT code 19001. Hope, you would now understand when and how we should use add on CPT codes.

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Modifiers used with Add on codes


Modifier are little confusing to use. I have already shared about using 25 and 27 modifier. Earlier we use to mostly 59 modifier to use along with add on codes when used more than once. However, with the introduction of X- modifiers now we are little careful while using modifiers. I have already shared about new X-{EPSU} modifiers previously. This will helpful for you about using these new modifiers. It depends on the Encounter, Practitioner, Structure and Unusual procedure done with add on CPT codes. Below example will help you in using the X-modifier

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When the same Add on CPT code used more than once

This is very confusing for few medical coders who don’t understand which X modifier should be used for repeat CPT code. Now, when a breast localization device like wire or clip is placed under stereotactic guidance on first lesion we have to use primary CPT code 19283. For each additional lesion, we have to use separate CPT code 19284 as add on code. Now, if again a localization device is placed under stereotactic guidance to third lesion, we will use again 19284 CPT code.  Now, as this add on code is repeated we have to use modifier to differentiate it from the first one. As both these add on code are performed on different location or structure we will use XS modifier with any of these add on code. Hence, the placement of breast localization device on these three lesions will be coded as

19283, +19284, +19284-XS

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Never use 51 modifier along with Add on codes


Add on codes are exempted from using  51 modifier. This modifier is used for multiple procedures, but add on codes itself considered as “additional procedure”. In addition, they are always used as secondary procedure and hence there is no need to use 51 modifier along with procedures.

Please read below references for more information:

https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/Add-On-Code-Edits.html
https://www.aapc.com/blog/31823-quick-tips-to-apply-cpt-add-on-codes/
http://www.behavioral.net/article/cpt-code-changes-using-add-cpt-codes

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