Resident Assist 80/GC Mods

tfrick2

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Hello All,

John Smith University is a teaching facility whose billing educators have directed the coding department that they can and should bill separately for resident surgeons/assists, on procedures that are eligible for assistant surgical charges, for commercial and self pay patients only (no government payers).

Example:

Patient Jane Doe has a cystic lesion removed from her shoulder. The operative report lists Surgeon A as the primary surgeon, and Resident B as the assistant. The surgeon notes "we performed...", "We then..." within the report, then ends with the attestation: "I was [present and I participated during the entire procedure (does not need to include opening and closing)," signed by Surgeon A.

This was coded as 23071 GC LT for Surgeon A, and 23071 80 LT GC for Resident B.

We have given them CMS documentation stating that residents should not be billed separately, but we've been told that since they don't bill the resident charges to government payers, then those guidelines don't apply.

I am in desperate need of documentation, something in black and white, to show that they should not bill separately for the resident.

I greatly appreciate any information you can suggest to help me with this!
 
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