Wiki 2 surgeons -surgery assistant when INS doesn't recognize m-80

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2 surgeons - surgery doesn't recognize m-80
1 surgeons documents the surgery listing another surgeon as assistant. the cpt doesn't cover m 80 for the surgeon that did assist.
how can this be coded. E/M with time explaining this?
 
2 surgeons - surgery doesn't recognize m-80
1 surgeons documents the surgery listing another surgeon as assistant. the cpt doesn't cover m 80 for the surgeon that did assist.
how can this be coded. E/M with time explaining this?
A surgery is not an E/M service, so it would not be appropriate to use an E/M code for this - if the documentation says that it was an assist at surgery, then that's how it has to be coded. If the particular surgical procedure does not allow for an assistant but there is documentation supports that the procedure was complicated in some way that made an assistant medically necessary, then it may be possible to appeal a denial with the payer. But even if not, then it wouldn't be appropriate to represent the service as something other than what it is.
 
Since assist is not allowed. You could bill cpt 99360.

99360 does not fit the scenario here and would be incorrect, as it was not standby time.

CPT code 99360 is used to report physician standby service that is requested by another physician and involves prolonged physician attendance without direct (face-to-face) patient contact. The following criteria apply:
  • Standby time may not be billed if the physician is in attendance for less than 30 minutes.
  • The physician may not provide care or services to other patients during this period.
  • The code should not be used to report time proctoring or supervising another physician.
  • The code should not be used if the period of standby ends with the performance of a procedure subject to a global surgical package (e.g., during PTCA it is determined that coronary artery bypass is needed and anesthesia is performed for the bypass).
 
Since assist is not allowed. You could bill cpt 99360.
No! This is incorrect coding.

The restriction on assistants for surgical codes 33241 & 33244 (or any other codes) is a payer reimbursement policy - it is not a coding guideline. CPT does not state that an assistant modifier is not allowed for any particular codes.

If there is an MD assistant documented, then it is correctly coded 33241-80 or 33244-80. The payer will deny it if they follow this policy and your organization chooses to bill it anyway, but there is no other correct way to code this. It can be considered fraudulent to substitute other codes simply to try to get payment for something that you know a payer does not cover.
 
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