Wiki Auditing PA assist at surgery

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bennieyoung

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I’m being audited once again and I have a claim that I billed for the surgeon and on that same claim I billed for the AS who is a PA. So, when the auditor was listing her findings she dinged me twice. Once for the surgeon charge and again for the AS charge. They were on the same claim but only one report by the surgeon and he documented the PA's assist. There isn't a separate report from the PA. I understand I have to use the very same codes I determined when coding the surgeon’s report for the AS. Only difference is adding the AS modifier. I disagreed with the auditor's findings and told her that I thought it was maybe unfair to get two errors instead of one on this…
she replied to me... Both physicians submitted separate claims. Even though these claims are for the same procedure/encounter, they would be considered separate reviews for auditing and would be their own separate, independent findings.
Is this true? or do I have an argument? So, far this is all I have found to support my thoughts...
AS means a non-physician provider and they served as the assist at surgery. You bill this by using the same code you determined for the surgeon and just add the AS modifier to it. The AS claim is not separately coded as the AS doesn’t submit a report. There is only one report and it’s from the surgeon.
 
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What was the given reason for the error? Does the surgical procedure allow an assistant? Does the insurance allow PA's to assist? Something had to be incorrect on the surgeon's codes for it to be "dinged". More information is needed.
 
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Orthocoderpgu said:
What was the given reason for the error? Does the surgical procedure allow an assistant? Does the insurance allow PA's to assist? Something had to be incorrect on the surgeon's codes for it to be "dinged". More information is needed.
Click to expand...
I'm sorry, I should have been more clear. I had coded a 33426 (repair) when it was actually a 33430 (replacement). I agreed with the auditor on these findings. The surgeon wrote his note and included that the PA was an assist so all of that was done properly. I only have the one report from the surgeon and I agree the code was wrong... when I coded the surgeon's charges which were 33426, and the PA's assist charges 33426-AS on the same claim the auditor is saying these are two separate mistakes when I believe it should just be one. I'm not coding a separate report for the PA. Have I explained my conundrum better? I can include a copy of the surgeon's note if that would help? and thanks so much for your quick response... I really appreciate it!
 
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Whether or not your company considers this one error or two is their own personal policy. If it were billed to insurance, this would in fact be 2 separate claims, and 2 incorrectly billed services.
I think the auditor means the coding/audit findings are separate, independent findings vs the records are independent. If you made an error in coding the primary surgeon, you also carried that same error to the assist claim. While it was the same mistake, it did result in 2 incorrect claims.
 
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csperoni said:
Whether or not your company considers this one error or two is their own personal policy. If it were billed to insurance, this would in fact be 2 separate claims, and 2 incorrectly billed services.
I think the auditor means the coding/audit findings are separate, independent findings vs the records are independent. If you made an error in coding the primary surgeon, you also carried that same error to the assist claim. While it was the same mistake, it did result in 2 incorrect claims.
Click to expand...
well, dang... she did this on two claims and I was hoping to get two of those points back. Again, thanks so much for responding!
 
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