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Wiki Assist. Surgeon for 58561

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owenstonya

Networker
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Puyallup, WA
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I'm curious, we recvd denial from ins for the assistant surgeon charge for CPT: 58561 mod. 80, the assist was needed for the procedure and my coding companion shows it is allwable, could someone pls help!

Thank you!
TO:confused:
 
Asst surgeon

Did you call the insurance carrier for an explanation? I have found that even though modifier 80 may be allowed per coding rules, the carrier itself may not allow for assistant surgeon for certain procedures. Whenever possible, it is best for the person who schedules the surgical procedure and does the precertification to verify that an assistant surgeon is allowed and is included in the precertification authorization. Just an FYI for the future.:)
 
I did call, and you are correct! they don't allow assist, surgeons :( however I REALLY appreciate your tip on calling prior to vfy assists, that makes perfect sense!! thank you for your help!!!
 
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