Are add on codes modifier 51 exempt?

Modifier 51 can be used with other modifiers, when appropriate, except modifier 50. Patient with bilateral simple mastectomies (19303, 19303-50) would not be billed with modifier 51.

CPT definition of add-on codes: … 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 found in the CPT codebook are exempt from the multiple procedure concept (see the modifier 51 definition in Appendix A).

Carriers already assume during a hospital stay that multiple procedures will already be performed therefore designation of the exact nature and type of services rendered by the attending physician will still suffice for hospital medical billing claims. …

Like the Type I add-on codes, a Type II add-on code is eligible for payment if an acceptable primary procedure code as determined by the claims processing contractor is also eligible for payment to the same practitioner for the same patient on the same date of service.

CPT guidelines explain the 51 modifier should apply when “multiple procedures, other than E/M services, are performed at the same session by the same individual. The additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s).”

Medicare does not recommend reporting Modifier 51 on your claim; the processing system has hard-coded logic to append the modifier to the correct procedure code.

Yes, modifier 51 causes a 50% reduction in payment.

Modifier 51 impacts payment. … Modifier 51 impacts the payment amount, and modifier 59 affects whether the service will be paid at all. Modifier 59 is typically used to override National Correct Coding Initiative (NCCI) Edits.

The prohibition sign symbol is used to report codes that are exempt from modifier -51, but have not been designated as add-on procedures or services.

All add-on codes are modifier 51 exempt (see the Add-on Code description on page XV & Appendix A of the CPT manual). Being that add-on codes are essentially modifiers to primary service codes, it would not be appropriate to append a modifier.

Both services must be provided by the same person, and the “parent”/primary code and add-on “child” code must both be billed by the same provider for the same date of service on the same claim. for critical care services rendered up through 23:59 on that date.

Add-on codes have no global period assigned. They are instead “included” in the global surgical fee for the primary procedure. Add-on codes are “modifier 51 exempt,” and therefore are to be paid at full fee schedule value. Their assigned value accounts for the “additional” nature of the procedure.

In another variation, some employers apply a 50% work RVU reduction to services with modifiers 50 and 51, but do not apply a work RVU reduction to procedures with modifier 59.

Modifier 47 is considered invalid when appended to CPT codes describing anesthesia services (00100-01999).

Yes, modifiers 50 and 51 can be used together. Most payers and clearinghouses remove modifier 51, because their systems automatically calculate the 50% reduction based on RVU ranking, whether the practice applies mod 51 or not.

modifier 51 was designed for physicians, if you are coding for a physician then yes. if you are coding for the facility then the applicable outpatient hosp modifiers are on the inside front cover of the 2008 CPT Professional Edition, left column.

Applicable code edits will be applied to services submitted. The -51 modifier itself does not affect payment. Multiple surgical payment is based on whether the surgical procedure may be subject to a multiple surgery. Then the reduction would be based on the allowed amount.

Modifier 50: Same Site, Different Side Modifier 50 is for the “same session” Modifier 59 for the “same day” and the “same individual.”

Modifier 50 may not be submitted in combination with modifiers 52, 53, or 73 on the same line item. If the procedure is discontinued, only a unilateral procedure may be reported as discontinued.

Glossaryappendix E of CPTcontains a list of codes that are exempt from modifier -51 reporting rules and that are identified throughout CPT with a forbidden symbol.appendix F of CPTcontains a list of codes that are exempt from modifier -63.

Modifier 52 is outlined for use with surgical or diagnostic CPT codes in order to indicate reduced or eliminated services. This means modifier 52 should be applied to CPTs which represent diagnostic or surgical services that were reduced by the provider by choice.

CPT modifiers are added to the end of a CPT code with a hyphen. In the case of more than one modifier, you code the “functional” modifier first, and the “informational” modifier second.

The plus symbol identifies add-on codes (Appendix D of CPT) for procedures that are commonly, but not always, performed at the same time and by the same surgeon as the primary procedure. Parenthetical notes, located below add-on codes, often identify the primary procedure to which add-on codes apply.

Never use both modifier 51 and 59 on a single procedure code. If there is a second location procedure (such as a HCPCS code for right or left), use the CPT® modifier first.

Modifiers should be added to CPT codes when they are required to more accurately describe a procedure performed or service rendered. A modifier should never be used just to get higher reimbursement or to get paid for a procedure that will otherwise be bundled with another code.

To claim only the professional portion of a service, CPT® Appendix A (Modifiers) instructs you to append modifier 26 to the appropriate CPT® code. Appropriate Usage: To bill for only the professional component portion of a test when the provider utilizes equipment owned by a hospital/facility.

You should append modifier 26, “professional component” to a procedure code when you perform only the professional component of the service.

Eliminated Code CPT 50398 was typically billed along with an interpretation code such as CPT 74425, making a new bundled code necessary. The two new codes include converting a nephrostomy to nephroureteral catheter (CPT 50434), which requires more work than exchanging a nephrostomy catheter (CPT 50435).

It is essential to use both the Alphabetic Index and Tabular List when locating and assigning a code. The Alphabetic Index does not always provide the full code. Selection of the full code, including laterality and any applicable 7th character can only be done in the Tabular List.

This policy is intended to cover those uses of stereotactic computer assisted volumetric and or navigational procedures which could correctly be identified by theuse of CPT codes 61781, 61782 and 61783 (add-on codes), recognized for payment by Medicare, when their use is considered medically reasonable and necessary.

For example, Whipple procedure (52.8 RVUs) had the highest 30-day overall morbidity and frequency of SAEs (45% and 35%, respectively), while trans-hiatal esophagectomy (44.2 RVUs) had the second highest (32% and 21%, respectively), and partial hepatectomy (39 RVUs) had the third highest (25% and 22% respectively).

When billing, recommended practice is to list the highest-valued procedure performed first, and to append modifier 51 to the second and any subsequent procedures. In practice, most billing software, and most payors, will automatically list billed codes from most-to-least valued.