Tierni Posted Mon 16th of November, 2015 16:39:40 PM
We have issues when billing a PA as a 2nd assist. The PA's primarily assist with vein harvest. We live in CA, and CA allows a 2nd assist. However, our claims continue to be denied. We are billing the appropriate modifiers per MCR, but continue to have this issue.
We appear the denial, and it will then come back paid. However, this is becoming increasingly exhausting. Does anyone have advise to stop our denials so we can obtain payment the first time we bill our these claims?
SuperCoder Answered Tue 17th of November, 2015 04:54:39 AM
Avoid modifier AS in teaching hospitals If your surgeon uses a physician assistant (PA) to help out during surgery, you'll want to know the payer you're dealing with before appending either modifier AS or modifier 80 to your claim.
You should take care of 4 points for Reporting PA assists at Surgery:
Point 1: Check the Fee Schedule-
Before billing a PA as a surgical first assistant, you must know if the insurer will reimburse for the PA's services. For Medicare, the easiest way to do this is to consult the Physician Fee Schedule Database.
Point 2: Append AS for Medicare Patients-
The PA serving as a surgery assistant reports the same CPT codes as the primary surgeon. To indicate that a PA provided the services, however, you should append modifier AS to claims for Medicare carriers and some third-party payers.
Point 3: Use Caution in Teaching Hospitals-
Medicare Carriers Manual specifies that an assistant at surgery will not be reimbursed in a teaching hospital which has a training program related to the medical specialty required for the surgical procedure and has a qualified resident available.
Point 4: Seek Instructions From Private Payers-
Although Medicare generally holds firm to its guidelines, private payers may publish completely different rules for surgical assistants. Some companies will not accept the HCPCS modifier AS, and some will. Medicare always wants the AS, but when we submit our claims to Blue Cross/Blue Shield, for instance, we must use modifier 80.
NOTE- Before submitting the claim check these four points and make sure that the vein harvesting is not bundled with the primary procedure code you are billing.