Can assistant surgeons bill UNLISTED procedure codes?

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Can assistant surgeons bill UNLISTED procedure codes?

Postby pedscoder » Mon Aug 21, 2017 9:59 pm

Hi!

Can assistant surgeons bill unlisted codes? Per CMS physician fee schedule, unlisted procedural CPT codes don't 'allow' modifier As/80/82. Wondering if there is a loophole or way to appropriately get insurance to pay.

Thank you!
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Re: Can assistant surgeons bill UNLISTED procedure codes?

Postby admin » Tue Sep 05, 2017 7:49 pm

As with any CPT code, documentation for assistant-at-surgery should clearly state the necessity for the assistant surgeon, and which portions of the surgery included the assistant’s involvement, along with the nature of the assistance provided.

This won’t guarantee payment, but it at the very least paints a documentary picture of the assistant’s involvement. Your only hope once the documentation meets standard is an additional detailed statement from the surgeon on appeal. If that initial appeal is denied, based on the small amount of payment you are seeking for assistant-at-surgery services, it then becomes a cost / benefit analysis as to whether further appeals will be worth the time and expense.

Your question has been answered by J. Paul Spencer, CPC, COC
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