Wiki Pa opnote documentation

[Desperate Denise]

I just read a bunch of previous questions regarding PA opnote documentation questions, however, I am still confused.

We hired a PA several months ago and reimbursement has been an issue. When I review the coding edits and the assist is a "1". I seem to be getting denials on each procedure with a "1". Should we not have the PA assist on these cases? OR --- should we appeal these procedures? If the answer is yes how do I appeal the procedures if the docs do not document the reason for the PA being in on the case.

We have a meeting coming up and it would be great if someone could direct me to a source that details what the documentation requirements are for PA assists.

Would really appreciate your assistance!!!

Thanks

Denise

 

[RGALVEZ]

Here are a couple of links that I believe really break it down.

http://www2.aaos.org/aaos/archives/bulletin/aug06/coding.asp

http://www.paorthosociety.org/resources/01092008-SpineSurgeryCoVersusAssistant.pdf

Hope this is helpful.
Good luck!

Ray

 

[RebeccaWoodward*]

I just read a bunch of previous questions regarding PA opnote documentation questions, however, I am still confused.

We hired a PA several months ago and reimbursement has been an issue. When I review the coding edits and the assist is a "1". I seem to be getting denials on each procedure with a "1". Should we not have the PA assist on these cases? OR --- should we appeal these procedures? If the answer is yes how do I appeal the procedures if the docs do not document the reason for the PA being in on the case.

We have a meeting coming up and it would be great if someone could direct me to a source that details what the documentation requirements are for PA assists.

Would really appreciate your assistance!!!

Thanks

Denise

Per the Medicare Claims Manual...

0=Payment restriction for assistants at surgery applies to this procedure unless supporting documentation is submitted to establish medical necessity.

1=Statutory payment restriction for assistants at surgery applies to this procedure. Assistant at surgery may not be paid.

2=Payment restriction for assistants at surgery does not apply to this procedure. Assistant at surgery may be paid.

9=Concept does not apply.

Many carriers follow CMS' assistant surgery policy; however, some carriers such as workers comp may pay differently. If it's clear that the carrier follows CMS's policy, payment indicator 1 is not payable.

Click the link under "downloads"...Open up the PDF file and scroll down to pages 11-12

http://www.cms.gov/PhysicianFeeSche...scending&itemID=CMS1223394&intNumPerPage=2000