Wiki Assistant Surgeons and Tricare

[scooter1]

Hello Everyone,
We seem to be having a problem with our assistant surgeon charges being denied from Tricare. We use Physician Assistants for our
assistant surgeons. So we have been using modifier AS ( with the appropriate RT or LT ). We keep receiving denials stating
053: Surgical Assistants are not authorized. Doesn't matter what type of procedure, ( fractures, total joints, etc. ).
When we look at Tricare guidelines the definitions they have for all of the assistant modifiers seem different from
what we see in the CPT books.
Is anyone else having this problem, or do you have any ideas on what we should be coding ?
Thank you for any and all answers

 

[anelson01]

We are also getting your assistants denied. They are wanting to know why we used a PA instead of a resident or intern and also what job they performed during surgery. We have the Physician do a letter and send it with the appeal.

 

[Karen78]

We were having this issue too until we had our physicians document with the assistant documentation that a qualified resident was not available at that particular hospital or facility. Check with your facilities as well because they actually set the guidelines for what a "qualified resident" is. our facilities indicate only residents that are PGY-4 and PGY-5 are "qualified" as assistants.