Wiki Facet Injection Denials.. Assistant Surgeon??

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cassyn86

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Our office has nurse practioners that perform facet injections (64490-66495) and we are starting to get denials for the modifiers from UHC Commercial for these services. We have always had to send in records with the claims so that is nothing new but now we are receiving denial letters that say that the original denial was processed correctly according to the Assistant Surgeon Policy. When I go to this policy it is showing that Assistant Surgeons in the form of Nurse Practioners must use modifier AS. (There is also a list of codes eligible to be done by Assistant Surgeons and these codes are on this list) I am SURE that UHC is denying these claims because they want this AS modifier but my problem is that they are not acting as Assistant Surgeons. The nurse practioners are performing the service In Office with no surgeon.. Of course I try to tell UHC this but they keep telling me to refer to this policy and correct the modifiers.. but we do not want to bill it fraudulantly to get them to pay it. Can anyone help with this? Does this mean that the services HAVE to be done by assistant surgeons?
 
Yes we are using all of the NP's information because they are the sole person performing the service..
I am afraid that you are right and that they are saying the services can no longer be done solely by NPs but of course I cannot find anything clarifying this and their rep's do not have a clue..
 
That is what it looks like to me that if you are using an NP then they can be only in the capacity of an assistant. I have not had anything official on this but I have heard that facet injections are only allowable as a physician procedure.
 
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