Wiki 2 Surgeons on Cervical Fusion

[caromissunc1]

Greetings and Salutations!
I have an ortho doc that will only do a 3 level or more cervical fusion if a general surgeon scrubs in to establish exposure. He also has a PA that works with him. In the above scenario, he wants the general doc to "get credit" for the 22551 code with him as the assisting surgeon (modifier 80). Afterwards, he is to be the primary surgeon in the 22552 x2 with his PA as the assistant; as well as having the PA as the assist in codes 22840 and 22846. however, we are having a diificult time getting insurance to pay the assist for any of it, because all of the codes that we file for the PA are all "add-on" codes. Since we do not list her on the claim for the primary code, insurance does not want to pay her for any of it. Does anyone else have this dilemma? I have tried coding her as an AS on code 22551 anyway, and am not having much luck. I have suggested using a 62 modifier for himself and the general surgeon for the 22551 and coding her as an AS, he is not very amenable to this. Inevitably, we have to appeal the claim. Any ideas?
Perplexed in NC

 

[Nat]

anterior fusion

22551 should be billed for surgeons with modiifer 62- the PA with modifier 82,AS-if performed in a teaching hospital. If not in a teaching hospital use AS. All other codes your surgeon would be primary and the PA as only assistant.
Nat