Wiki Billing for a PA in Surgery

[kelly.armstrong]

I've been having and ongoing issue with our PA, who assists the primary surgeon in all surgeries. I only bill the PA when the procedure is authorized for an Assistant. He wants me to bill for every procedure, of every surgery, since he is listed not he OP note as the Assistant.

I always check what the Assistant Surgery Payment Indicator is. I only bill for him if the indicator is 2.

It looks like I can bill for him if the Indicator is 0, but supporting documentation must be submitted to establish medical necessity. What supporting documentation is required?

I still do not feel I should bill for every procedure he assists on, especially if the Payment Indicator is 1 - can not be paid.

Lastly, is there any backlash for me as a CPC if I start billing all procedures for the Assistant Surgeon, regardless of what the Payment Indicator is?

Thanks so much in advance.

Kelly

 

[Bready]

Billling for a PA in Surgery

Kelly,
AAPC did an article on billing for assistant at surgery 7/23/13. You can google: prompt proper assistant at surgery payment AAPC and the article should come up for you. I think it answers most of your questions except your liability as CPC. I personally think you have no liability but do show your provider the article of what is required to bill for assistant at surgery as he may be unaware of the medically necessity documentation needed to bill. If the surgery does not usually require an assistant it won't be paid. If his documentation in the body of the op report does not state the necessity of the assistant it most likely will not be paid. Just because the physician likes to have someone with him helping him doesn't mean it meets medical necessity. Unfortunately these rules/requirements came about because some physicians were abusing the payment system and now we have more hoops to jump thru!
Good luck.

 

[kelly.armstrong]

Bready, thanks so much for you very quick and helpful reply. I have looked at the article you referenced. There is a lot of great information there. I have printed it to show to the Assistant Surgeon.


Thanks again for your help!