Wiki assistant surgeon billing question

[scooter1]

the CPT codes are
29806
29826

We have an insurance company denying payment for the assistant surgeon on
29826, because it is an add on code to a procedure that doesn't allow for an
assistant.

Has anyone else had this happen? This is the first time I know of that we have had
this. Any recourse ?

 

[AllisonTanksley]

I haven't had this happen with an assistant surgeon service, just a primary surgeon service. I would suggest appealing with the NCCI list from Medicare that shows assistant surgeon as appropriate for CPT 29826. You may also have to consider your payer. Some commercial insurances will follow Medicare guidelines and others only follow them in certain situations or not at all. Take a look at the payers policies. Good Luck!
~~Allison Tanksley, CPC