Guna Posted Thu 29th of January, 2015 09:23:46 AM
CPT 11046 is an add-on code for primary code 11043; since assistant surgeon (Mod-AS) is applicable for add-on code (11046) only not a primary code (11043). Please advice how can we report both these codes for Assistant surgeon (here is PA).
SuperCoder Answered Thu 29th of January, 2015 10:03:08 AM
Thanks for your question. 11043; Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); first 20 sq cm or less does not allow assistant surgeon reimbursement which is why you are unable to use the AS modifier with this procedure code. Procedure code 11046; Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); each additional 20 sq cm, or part thereof does allow for assistant surgeon reimbursement when supported. This code would be the only option for billing an assistant surgeon.
Guna Posted Fri 30th of January, 2015 05:35:38 AM
Thanks for your reply. Since CPT 11046 is an add-on code and we cannot report this code alone;then it should be billed with CPT 11043 but this code is not allowed for assistant surgeon. Then how can we report CPT 11046 alone to assistant surgeon.
SuperCoder Answered Fri 30th of January, 2015 10:22:16 AM
You should bill both codes with the AS modifier and allow the insurance company to process the claim according to their policy. You should bill it because there was an assistant although you know the primary code will more than likely be denied. Hope this helps.