Using Add-On Codes

by  Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
March 3rd, 2017

There are certain procedures that are carried out in addition to the primary procedure called add-on codes.  They describe a specific type of supplemental procedure done in addition that are labeled as add-on codes.  

The AMA gives instructions and guidelines with notations such as "List separately in addition to primary procedure" or "each additional". You will also see a "+" sign or icon next to the procedure code. 

Example of an add-on code: 

Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT)

     64479   cervical or thoracic, single level
+  64480   cervical or thoracic, each additional level (List separately in addition to code for primary procedure) (add-on code)

Reporting 64479 -LT with the add-on code +64480-LT would be correct. 

Modifier Usage:

These type of codes cannot be reported alone or as a stand alone code and are also exempt from the modifier 51 (Multiple Procedures).  Using modifier 51 will not pass NCCI edits. Incorrect use of modifiers can be considered fraudulent or abusive.  

Modifier 59 (Distinct Procedural Service) would also not apply to an add on code.  The description of modifier 59 indicates "documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual."  Although there may be times when the modifier 59 may be required.  For example, if there was another procedure done in addition.

Note: Be sure you watch for bundling edits anytime you use this modifier.