Primary/Assistant surgery claims

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I know this sounds crazy, but can someone guide me to the documentation stating I cannot bill a primary surgeon and an assistant surgeon on the same claim. I bill for a group of Ob/gyns and very commonly they assist one another. We bill under the same NPI and tax id. I cannot find ANY documentation stating they cannot be billed on the same claim. I bill each line appropriately with the correct physician listed and a modifier 80 on the assist but priority health is telling me this comes up against a new edit. I cannot find this edit anywhere!! Please help.
 

cblack712

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I am going to throw this out there for you as just a thought -- I am not in your situation and don't know more than what I see here - this is just similar to something my office came across once (different carrier though)

Maybe it is the fact that you are using the 80 mod - they may be looking for the 62 mod.... look at this link - there is a link on there for the 80 modifier too.

http://www.priorityhealth.com/provider/manual/billing-and-payment/modifiers/62

Also some CPT codes are not eligible for reimbursement for the co-surgeon. Check this website to see if your CPT can be billed with either modifier.

http://www.cms.gov/PhysicianFeeSched/PFSRVF/list.asp?listpage=3

When the rep is telling you that "they can't be billed on the same claim" he/she may be referring to the procedure.

On the same hand insurances are implementing new things all the time. Here is one resource that I found as well that may help!
http://www.cms.gov/ContractorLearningResources/downloads/JA6319.pdf

Sorry I couldn't be more help!
 
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