MBRAMEL
New
Can you help with assistant surgeons on cpt 43770-AS using this medicare
denying? why? thanks
denying? why? thanks
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Wiki Medicare
- Thread starter MBRAMEL
- Start date
RebeccaWoodward*
True Blue
According to Medicare's fee schedule, assistants are payable for this procedure. What type of denial reason did you receive from Medicare?
CMS requires not only the AS to identify the assistant is a NPP, they also require either 80, 81, or 82 as well.
http://www.cms.gov/MLNMattersArticles/downloads/MM6123.pdf
Payment
Medicare pays for a surgical assistant when the procedure is authorized for an assistant and the person performing the service is a physician, physician assistant (PA), nurse practitioner (NP) or a clinical nurse specialist (CNS).
To facilitate payment, CMS (under authority of 42 CFR Section 414.40) has established uniform national definitions of services, codes to represent services, and payment modifiers to the codes, to include the use of payment modifiers for assistant at surgery services.
To bill for these services, you should use Modifier 80 (assistant surgeon), 81 (minimum assistant surgeon), or 82 (when qualified resident surgeon not available). You should also use Modifier AS when you need to indicate that a PA, NP or CNS served as the assistant at surgery. Be aware that when you use Modifier AS, you must also use Modifier 80, 81, or 82 because using these modifiers without modifier AS indicates that a physician served as the surgical assistant. Claims that you submit with modifier AS and without modifier 80, 81 or 82 will be returned to you.
I know the MLN is talking about CAH but this rule applies to all settings for an assistant, its just the easiest link to find.
I know a lot of claims get paid with just the AS, my personal opinion is this happens for the same reason a lot of claims get denied in error, they don't always pick up the 2nd, 3rd, etc modifier, and these have actually been paid in error.
Laura, CPC, CPMA, CEMC
http://www.cms.gov/MLNMattersArticles/downloads/MM6123.pdf
Payment
Medicare pays for a surgical assistant when the procedure is authorized for an assistant and the person performing the service is a physician, physician assistant (PA), nurse practitioner (NP) or a clinical nurse specialist (CNS).
To facilitate payment, CMS (under authority of 42 CFR Section 414.40) has established uniform national definitions of services, codes to represent services, and payment modifiers to the codes, to include the use of payment modifiers for assistant at surgery services.
To bill for these services, you should use Modifier 80 (assistant surgeon), 81 (minimum assistant surgeon), or 82 (when qualified resident surgeon not available). You should also use Modifier AS when you need to indicate that a PA, NP or CNS served as the assistant at surgery. Be aware that when you use Modifier AS, you must also use Modifier 80, 81, or 82 because using these modifiers without modifier AS indicates that a physician served as the surgical assistant. Claims that you submit with modifier AS and without modifier 80, 81 or 82 will be returned to you.
I know the MLN is talking about CAH but this rule applies to all settings for an assistant, its just the easiest link to find.
I know a lot of claims get paid with just the AS, my personal opinion is this happens for the same reason a lot of claims get denied in error, they don't always pick up the 2nd, 3rd, etc modifier, and these have actually been paid in error.
Laura, CPC, CPMA, CEMC