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Lora

Hattiesburg Posted Thu 13th of April, 2017 15:05:48 PM
We have not been able to add modifiers to add on codes in the past. Can you tell me if something has changed? Example: when doing cci edit check on these codes in super coder for 22551,22853 and 22845 it states 22845 should have a modifier.
SuperCoder Answered Fri 14th of April, 2017 11:02:55 AM

Hi,

 

As per coding guidelines no modifier is allowed with add on codes. Appending modifier 59, or any modifier, on an add-on code is inappropriate, unless your payer specifically requests you to do so. Please consult with the payer.

Hattiesburg Posted Mon 17th of April, 2017 14:44:25 PM
Code 22845 is a column 2 code for 22853 , but a modifier is allowed in order to differentiate between the services provided. *Use modifier with code 22845 CCI edit Rule: HCPCS/CPT procedure code definition In your CCI Edit this is showing that a modifier is needed for 22845. Please review and advise.
SuperCoder Answered Tue 18th of April, 2017 10:53:56 AM

Hi,

 

Yes! CCI edit shows bundling in SuperCoder when the date or version is Apr 1-Jun30, 2017 but if you check CCI edit for date Jan1-Mar31, 2017 then, there is no CCI edit for addition of modifier. This data is updated according to CMS and I would suggest you to check your date of service and check CCI edit for that date of version and also check with the Medicare because the new data is updated according to CMS. 

Hattiesburg Posted Tue 18th of April, 2017 14:00:31 PM
Hi, My date of service is after April 1, 2017 so would the add on code 22845 need a modifier? If so can you please send a reference that shows add on codes can now have modifiers added. Thanks
SuperCoder Answered Wed 19th of April, 2017 06:29:08 AM

Hi,

Usually no modifier is needed with CPT code 22845, when billed along with CPT code 22853. This is how CMS was showing it under CCI edits of 1st Quarter 2017, i.e., for Date of service Jan. 1st to March 31st, 2017.

 

But CMS has changed the CCI edits for 2nd Quarter 2017 and now showing bundling of CPT code 22845 into 22853. This is not making sense, as these 2 procedure codes cannot be get bundled in each other. So, we suggest you to get in touch with Medicare/CMS to report this issue, as it will impact your reimbursement.

 

SuperCoder CCI edits checker tool is showing the data, which CMS has provided. Once CMS rectify the error, we will make the necessary changes.

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