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Wiki Surgical assistant billing

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bkhattak

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Hello, I would really appreciate if someone can help me out with billing for an assistant surgeon. I have just started working for a plastic surgeon and he has decided to use an assistant surgeon in one of his surgeries for breast reduction. I would like to know if we have to use different codes or use the same codes with modifiers.
 
A dumb question: If we are billing for 19318 and have an assistant surgeon on board. Do we have to bill 19318 once with modifier 80 or we have to bill it twice with one of them with modifier 80?

Thank you
 
bkhattak said:
Does it apply to Medicaid Texas and commercial insurances?

Thanks
Bilal
Click to expand...
I am not aware of any commercial insurance payors that do not follow the CMS assistant surgeon guidelines. Regarding Medicaid, each state is different and I would suggest reviewing your state's guidelines for assistant surgery.
 
bkhattak said:
A dumb question: If we are billing for 19318 and have an assistant surgeon on board. Do we have to bill 19318 once with modifier 80 or we have to bill it twice with one of them with modifier 80?

Thank you
Click to expand...
If you have two physicians, you will have two claims. Check the link I provided for appropriate modifiers.
 
bkhattak said:
A dumb question: If we are billing for 19318 and have an assistant surgeon on board. Do we have to bill 19318 once with modifier 80 or we have to bill it twice with one of them with modifier 80?

Thank you
Click to expand...
The primary surgeon bills 19318.
The assistant bills 19318 with -80, -81, -81, or -AS as appropriate for the circumstances.
Don't forget the instructions at the top of Sharon's link. The op note should document what the assistant surgeon did.
 
Can we bill for surgical assistants? certified or not certified. These are non licensed personnel I am taking about. Not doctors, nurse practitioners, clinical nurse specialist or physician assistants. If they are not billable to the insurance, would it be at the doctor's expense?
 
If you are talking about someone who's a surgical tech, that is not billable. If it's in a facility, the facility will typically provide that type of staff if needed. If it's office based surgery, then yes, the practice would pay the employee. Just like you would pay a recovery nurse, but can't bill for it. It's part of your expenses.
MD, DO, MBBS, PA, NP and various CNS are all billable assistants. RNs are not unless they are also CNS. The scope of practice for the billable assistants is far greater than RNs and surgical techs. Reimbursement for assistants is in the ballpark of 16-20% of the primary surgeon's if the procedure allows an assist. Also remember that if you have qualified billable assistants, they can also help with discharges, writing prescriptions, etc., so your primary surgeon might be able to be more productive.
 
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