Wiki Codes 20985 and 20985 AS

[kback68@yahoo.com]

Could someone please help me with billing for 20985 and 20985 AS-to Medicare? Can you charge the patient for the 20985 AS? Does the patient have to sign an ABN first and then we can charge them if Medicare does not pay?

 

[aprilroc]

From the edits in the Coding Companion for Orthopaedics, assist at surgery is only covered with documentation of medical neccessity.

You don't need ABN if this could be covered by Medicare and no wouldnt think you could bill this if it does not meet Medical Neccessity.

You can appeal with Op notes to prove this to Medicare, but be sure your records clearly states what role the assistant preformed and the need.

 

[mnk8383]

Our practice is currently being paid for 20985 and 20985AS from Medicare. However we are having trouble with the Medicare Advantage Plans. They are suppose to follow Medicare guidelines but I have had to appeal several (Humana, Unicare, Secure Horizons). I am currently doing a third party review so I will let you know what their decision will be.

 

[denarh40]

20985as

Just curious..did you ever get that third party review? I am new to coding ortho and not sure about billing 20985 AS.

Thanks
Dena CPC

 

[mnk8383]

I got one paid by Secure Horizons after the third party review and Im trying on the rest. Let me know if you gain anymore info?

 

[douellet]

We have Harvard looking for a 59 modifier, are you using a modifier ? Thanks.