Wiki General Surgeon "Fellow"

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hsmith67

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Surgeon A is primary surgeon, performs left mastectomy. Surgeon B is a Fellow that is acting as an assistant surgeon and performs right mastectomy at same time. Surgeon A is in OR entire time Surgeon B is, Surgeon A dictates note for himself and in the note refers to Surgeon B as the assistant surgeon and dictates what Surgeon B performs. Surgeon A desires billing for himself as primary, billing for Surgeon B with mod-80, and one note from Surgeon A. Is this OK or not? Thanks, Hunter Smith, CPC
 
Medicare makes payments to teaching hospitals for training residents and fellows in approved training programs. Fellows cannot bill for the services they perform during their training program.
 
I work with a practice that does have a 1 year NON ACGME fellowship, and the "fellow" is a fully licensed physician and employee of the practice. In that unique situation, the practice bills for the work of the "fellow" (under the fellow and must credential the fellow).
So, while it is possible, almost all fellowships are ACGME approved fellowships and the fellow is not an employee of a practice. In those cases, the fellow work is handled the same way as resident work. As explained by @cgaston above, the fellowship program receives funding and cannot separately bill for the fellow's training. It is possible that Dr. A can bill for the services as a teaching physician with -GC modifier. You should carefully review the teaching physician guidelines.
 
csperoni said:
I work with a practice that does have a 1 year NON ACGME fellowship, and the "fellow" is a fully licensed physician and employee of the practice. In that unique situation, the practice bills for the work of the "fellow" (under the fellow and must credential the fellow).
So, while it is possible, almost all fellowships are ACGME approved fellowships and the fellow is not an employee of a practice. In those cases, the fellow work is handled the same way as resident work. As explained by @cgaston above, the fellowship program receives funding and cannot separately bill for the fellow's training. It is possible that Dr. A can bill for the services as a teaching physician with -GC modifier. You should carefully review the teaching physician guidelines.
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Thanks so much. Now... it appears the surgeon is post residency and working toward becoming a "Fellow of the ACS", he is not doing a "fellowship in a surgical sub-specialty", he can perform and bill surgeries by himself, is employed by the practice, and is credentialed with the payors. Dr. A is already a "Fellow of the ACS" and asks Dr. B to assist him on a bilateral mastectomy. Dr. A dictates the entire note and refers to Dr. B as a "secondary surgeon". When questioned by coder he says "he's an assistant and he is assisting me however I tell him to" and wishes the board certified, residency completed general surgeon to be billed out with mod 80 as an assistant. Is this allowed?
 
I think I understand. So in your case, both physicians are fully licensed and credentialed. Physicians do not need to be board certified to be fully licensed and treat patients. Dr. B is simply new and working under some additional guidance of a more experienced surgeon on complex cases.
As long as the procedure performed allows an assist, then billing for Dr. B with -80 seems correct. The documentation supports Dr. B's assist.
I will note - if the facility is a teaching facility, you may want to review modifier -82. IF it is a teaching facility, then the ACGME program residents/fellows are typically expected to be assistants.
 
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