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assistant surgeon and CCI edits

K Posted Fri 22nd of May, 2020 16:28:53 PM
Hello, Our provider performed an arthroscopy of the knee and we billed 29873 and 29875-59. The claim was process and paid. Our provider had an assistant surgeon and the charges were billed and both denied. How can you get a code paid that does support an assistant surgeon (29875) , if you have a CCI edit with the primary CPT code (29873)? CPT code 29873 is not payable to assistant but 29875 is payable. Thank you for your help with this!
SuperCoder Answered Tue 26th of May, 2020 07:47:53 AM


Thank you for your question.

The assistant surgeon for CPT code 29875 will be paid when billed with modifier AS. So, bill 29875 with AS (Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery) and 59 (Distinct Procedural Service). Feel free to ask for any further query.

K Posted Tue 26th of May, 2020 10:37:20 AM
We did bill with modifier AS and 59 and it was denied due to the CCI edit with the other code we billed 29873. Do we bill both codes or do we only bill the 29875? If we should bill both codes, how do you recommend us appealing the claim to get code 29875 paid?
SuperCoder Answered Wed 27th of May, 2020 10:06:06 AM

I would like to know the reason for denial with denial code.  Sometimes there is Payment restriction for assistants at surgery, and it applies to this procedure as well, unless supporting documentation is submitted to establish medical necessity.

Also, It might be possible that the AS is an assistant surgeon, for which 80 modifier will be eligible or 81, not AS.

Modifier 80: Assistant Surgeon.

Modifier 81: Minimum Assistant Surgeon.

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