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Assistant Surgeon billing CPT codes that the Primary Surgeon did not

Dempsey Posted Fri 24th of February, 2017 12:06:38 PM
I have a bill where the Assistant Surgeon (PA), billed 23410-81, 23430-82, 29826-81 and 29823-81. The Primary billed 23410, 23430 & 29826. Now can the assist bill 29823-81 if the primary surgeon did not? Also if the primary did not bill 29823 and is documented in the op note can the assistant bill for the procedure even though the primary did not bill the 29823?
SuperCoder Answered Mon 27th of February, 2017 02:20:42 AM

CPT code 29823 gets bundled in CPT code 23410 which means the service of this code is included in the major surgical procedure. This code will not be reimbursed seperately unless the medical documentation suggests otherwise. That is the reason why CPT code 29823 has not been billed by the primary surgeon. Assistant Surgeon too should not bill for CPT code 29823. If the AS still wants to bill for this service, AS will get denial for CPT code 29823 as it will be considered as a bundled service.   

Dempsey Posted Mon 27th of February, 2017 07:53:00 AM
I understand the bundling issue, but what I want to know is can the assistant surgeon bill for code(s)that the primary surgeon did not bill for? I get HFCA's for the assistant billing code(s) with modifier 80, 81, 82 or AS that the primary did not bill for. From what I was told by other coders the assistant surgeon can't bill for codes/services and get paid for if the primary surgeon did not bill for. This is regardless if the service is in the op report or not.
SuperCoder Answered Tue 28th of February, 2017 01:21:05 AM

Yes, you are right. If the primary surgeon has not billed the service, assistant surgeon cannot bill for this service. 

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