Wiki Billing for an assistant surgeon

[robin@tnoculoplastics.com]

I work for an oculoplastic surgeon who recently did a DCR procedure. He used another of our physicians as an assistant surgeon. They want me to bill the primary doctor using CPT 68720 and then put a 80 next to it. Would that not signify that he was the assistant surgeon? My thought was that i needed 2 encounters, one for the surgeon billing 68720 and another encounter for the assistant using 68720/80. I do not want to have the primary surgeon's fee cut by using the 80 modifier.

Thank you

 

[thomas7331]

Yes, the assistant claim needs to be billed with the credentials of the physician who was acting as the assistant. You don't necessarily need two claims or two encounters, but the claim line for the surgeon should have the surgeon's NPI as the rendering provider, and the claim line with the modifier needs to have the assisting physician's NPI.

 

[robin@tnoculoplastics.com]

thank you for that information! Does/can the assistant surgeon also be as the rendering? We use Nextgen and when putting in charges our only options are rendering/ referring or supervisor, so not really sure how to put her in. I tried adding another line on the rendering claim using the 68720/so and her name but it would not clear edits for having 2 physician names on the claim.

 

[thomas7331]

thank you for that information! Does/can the assistant surgeon also be as the rendering? We use Nextgen and when putting in charges our only options are rendering/ referring or supervisor, so not really sure how to put her in. I tried adding another line on the rendering claim using the 68720/so and her name but it would not clear edits for having 2 physician names on the claim.

I'm not familiar with how Nextgen maps information onto the claim form so that's a question you'd probably need to ask your IT people or your software vendor. The rendering physician (box 24J of the claim form) will need to match the physician who performed the service that you are billing on each particular line, so the rendering physician will be the assistant on the line that has the 80 modifier. Depending on how your software is set up, you may or may not be able to combine services for multiple rendering physicians on one claim form. But if you're getting an error for having 2 different physicians on one claim, then you likely need to create two separate claims.

 

[amyjph]

You'll need to make a separate encounter in NextGen, you can't have both claims in the same encounter if it's setup how I think it is. You can't "mix" providers. You are correct, you make one encounter for the primary surgeon charges. Make a second, separate encounter for the assistant-at-surgery charges with the 80 mod and you'll have to lower the fee or they might reject as a dupe even if it has the 80 mod. Same goes for mid-level assistants like PA (which may need 81 or AS not 80).