Wiki 2 primary surgeons?

[rflacy1]

Hello! I'm new to AAPC and this is my first question to forum.
Is it allowed for two surgeons to both bill the same CPT codes on the same date (and place of service)
without one billing as an "assistant" with modifier 80 or AS?
They are both billing same ortho CPT codes (29807,29898, 29891, 23412).
One of the surgeons is billing exactly half the charge of the other surgeon for each CPT code.

 

[Orthocoderpgu]

You cannot have two primary surgeons on the same procedures. Codes 29807 and 23412 are both shoulder codes. Codes 29898 and 29891 are both ankle codes. I can see one doc billing the shoulder codes as primary and maybe the other doc billing the ankle codes as the primary. If that is true they could have assisted each other. But no, you can't have both providers bill the same exact charges.

 

[rflacy1]

Ok thank you. This makes sense and will help with documentation. I forgot to mention the shoulder vs ankle CPT codes were on 2 separate dates of service. I'm pretty sure the doc billing the lower charge is intending to bill as the assistant. I really appreciate your help!

 

[amyjph]

The question is a bit confusing. There are a couple concepts possibly at play. You would want to read and understand the meaning of co-surgery first I think (however from your question that's not what you're talking about). In the ortho world, there are some CPT codes (usually spine) which allow co-surgery. Co-Surgery means the individual skills of two surgeons are required to perform surgery on the same patient during the same operative session. This may be required because of the complex nature of the procedure(s) and/or the patient's condition and the additional physician is not acting as an assistant at surgery. Modifier 62 Fact Sheet

The codes you refer to above do not allow co-surgery and it would not make sense that they would. What you are talking about is assistant-at-surgery. An "assistant at surgery" is a physician who actively assists the physician in charge of a case in performing a surgical procedure. The "assistant at surgery" provides more than just ancillary services. The operative note should clearly document the assistant surgeon's role during the operative session. Most times a PA is an assistant-at-surgery.

Assistant at Surgery Modifiers Fact Sheet

www.novitas-solutions.com

Assistant at Surgery Modifiers

www.novitas-solutions.com

If you are working in a teaching facility these concepts are different and you would need to understand those rules as well for residents, etc.

The assistant-at-surgery claim will have 1/2 the fee of the primary surgeon. However, in your CPT above, not all even allow billing for an assistant.

 

[Orthocoderpgu]

Ok thank you. This makes sense and will help with documentation. I forgot to mention the shoulder vs ankle CPT codes were on 2 separate dates of service. I'm pretty sure the doc billing the lower charge is intending to bill as the assistant. I really appreciate your help!

If one assisted, it needs to be documented that way.