Wiki Assist Surgeon on C-Sec?

[kstine713]

I have read through a bunch of threads on here, and the responses seem to be all over the place. I'm thinking maybe the answer is situational? Here is my scenario:

Provider A provides *almost* all antepartum care.
Provider B provides some antepartum care. *Pt is high risk and had more than 13 visits*
Provider A delivers, and provider B assists.
Provider A provides antepartum care.

Best billing practice for said situation?

If provider A bills 59510, can provider B bill for assisting on the c-sec?

Any help is appreciated!
Thank you!!

 

[thomas7331]

Assisting at the surgery is separate from the rest of the global package, so Provider B should bill 59514-80 for the work of assisting. I believe most payers' policies do not allow 59510 with an assistant modifier since it is a global charge and there is no assistant fee for the antepartum and postpartum portions of that code.

 

[csperoni]

Correct, you cannot bill assist on C-section global package. You can bill assist for the surgery 59514-80. If both providers are part of the same group, then the visits by Dr. A and Dr. B are both bundled into 59510. If the docs are not part of the same group, I would wonder why the patient was seeing 2 docs for her antepartum care. Dr. A should have provided all necessary care. If they are different groups, but cross-cover, then most practices either make an agreement to pay the other practice $x per visit or call it a wash if 50% of the time Dr. A sees covering for Dr. B and vice versa.