Wiki Billing 59 mod vs AS modifiers, which is listed first on a claim? please advise

[melanied]

I work with Neurosurgeons and NPPs. Our NPP assisted on a surgical case and we billed the modifer 59 before we added AS modifier ( see example line 2). Our claim was paid but now they are recouping a portion of that line item (line 2)
example:
22551 AS
22845 59 AS
22552 AS
22853x2 AS
20937 AS

Was this billed correctly with modifier 59 and then modifier AS on line 2? Please advise. Thank you

 

[amyjph]

Without seeing the op note it's hard to say if it was totally correct. It really shouldn't matter which position the 59/AS are in. Usually you want "money" modifiers to go first so the 59 should be 1st but the payer could want the AS first. I've never seen it matter in my experience, but the payer might have an edit/review set up. What does the reason for recoup say, was it only a part of it? Was the plate a stand alone plate and not integral to the the interbody spacer? Was the assistant's name correctly attached to the assistant-at-surgery claim? Did the surgeon's claim have the correct modifiers and information? I have seen where someone accidentally appended AS to a surgeon claim or forgot the AS on the assistant claim and that causes issues.

 

[Cmama12]

What was the reason given for the recoup?

Our guidelines are 1. organizational/pricing 2. CPT/HCPCS 3. Medicare. But some modifiers fall into more than one category. 59 is a CPT mod, and AS is a pricing/hcpcs according to the list. Since AS affects pricing, I would list it first.

I am not at all familiar with ortho codes, but do you usually bill 22845 with 22853?

 

[amyjph]

You can only bill 22845 w/ 22853 if the plate is stand alone and not integral to the interbody device.

Both the 59 and the AS impact pricing. We are shooting fish in a barrel without knowing more info for the recoup. Did they price it wrong in the first place? Are they taking back the entire payment on that line? Etc. Etc.