Wiki PA Assist in Surgery- questions

[devorahedelman@gmail.com]

We generally concentrate on psych billing, but have a friend who is a PA we said we would help out.

The PA recently did an assist on a laproscopic appendectomy in the ER.
The PA is out of network with the insurance company.

We billed it with the regular codes that the doctor billed, but with the modifier AS.

We got notice that the insurance is paying out a very small amount, and it is going straight to the patient.

-Is our billing affected by the surgeons billing? The patient told me that the surgeons biller we having trouble getting everything correct, and is paying out very little.
-In general, out of network gets paid to the patient, but does that apply to ER cases as well?
-Are there separate codes that we need to do for ER cases? We just billed 44970 with the AS modifier.

Thanks

 

[devorahedelman@gmail.com]

anyone?

 

[LLovett]

Assistant surgery payments are very low.

Medicare would only pay approx. $76 for that procedure done by a PA. If it was another physician they would only pay about $90.

Your billing should not be affecting the surgeons billing. I can't really speak to how a commercial carrier handles out of network ED visits.

Hope this is somewhat helpful,

Laura, CPC, CPMA, CPC-I, CANPC, CEMC