Wiki Help with Assistant billing

[bovapj@yahoo.com]

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Hello
I am looking for some guidance.
I work for WMG in Warren,PA
We use the CMS website and then A list of procedure codes for which Medicare will not reimburse a first assistant-at - surgery paper that applies to all first assistant's, PA's, MDs and NP's.(which i have gotten off the web and is updated every year.)


Which is actually correct.
We get some insurances (bc,uhc) that seem to follow their own rules.
And then the CMS for Medicare, but they sometimes dont pay, even when it says that they take one assistant..

Please any help would be great. thanks
Patti

 

[teresabug]

first, there are specific modifiers to attach to the CPT code for assistants; they vary depending on "who" is assisting: for an MD 80 or 82.
For a PA the modifier is AS.
Documentation for this is key. The assistant has to be listed on the operative report by the actual surgeon that they are assisting. Also key for them to dictate specifically "what" the assistant did. Then appeal the claim with the op report.

 

[bovapj@yahoo.com]

Yes, that I do know.
But what do you use I do mostly Assitant at surgery PA-C
And try to use the CMS as much as possible.
But they don't seem to stick to it.
Should I appeal them all?
When it says in the CMS that it will take one Asst and they deny it at mcr?
thanks