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Wiki How do you determine if an assistant is allowed?

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decoderman1957

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I know CMS has guidelines which state if an assist is allowed, sometimes allowed or not allowed. Is there another source I can use for my physicians who say "This isn't a medicare patient so bill an assistant." 95% of the time the assist is denied and we have to file a pointless appeal.

If you know of a resource other than CMS, please let me know.

I look forward to seeing everyone in Long Beach.
 
If you have your RVU file from the Federal Register, you should look at column AA. If you see a number 2 listed in this column, an assistant is allowed.
 
Assist Guidelines

Hello!

Most Insurance companies follow NCCI guidelines on Assists. They also publish the policy. I would call your provider rep if you can't find it on thier webiste.

Hope that helps :)

Michele
 
Good Morning

Just to let you know where I work we use Encoder Pro and it is a wonderful tool for coders. Not only does it list if an assistant can be use with a cpt code, it also gives rules and regulations from medicare and other helpful hints with your coding.
 
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