Wiki Coding for a PA as an assist and getting paid!

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cassiebabarovic

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I work for an Ortho Doc that uses a registered PA for all his surgeries as the assist. We bill for him with an 80 mod but they always get denied and when I appeal along with the op-report we will get paid sometimes and sometimes not. Does anyone know why that is?
 
Thank you for your replies. I have tried to bill with the AS mod also but they still deny even on appeal. Even with the Dr stating the necessity of an assist. Did not know if anyone has experience with PA's and if it is just some carriers will pay and others don't?
 
Our practice has surgeons and PA assists. Some procedures do not warrant the need of an assistant.

This link will indicate if a procedure warrants an assistant.

http://www.cms.hhs.gov/pfslookup/02_PFSsearch.asp?agree=yes&next=Accept

click on Single HCPC Code

click on Payment Policy Indicatiors

click “next”

click “next”

enter your CPT code in the “HCPC” box

select your drop down key in the “modifier” box and select “all modifiers”

click “submit”

In the "ASST Surg" column-

0=payable with documentation of medical necessity
1-not payable
2=Assist payable
 
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I work for an ortho practice as well. You will find that some carriers will pay an assistant charge and some will not. Good luck :)
 
Most carrier's have a list that you can obtain that will tell you which procedure that an assist payment is allowed for (including Medicare). I would recommend thatyou obtain these and use these for purposes of denials if needed.

I recently gave my docs a list of procedures that are not covered by 90% of the payors. They use our PA's for even the simplist cases, cause they want the PA's to do the suturing. I told them to stop being lazy and do it themself :) They hate when they see memo's from me..they know its going to require more work for them!

hope this helps shed some light
Mary,CPC,COSC
 
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