Question Two Assistant Surgeons

clark.amy86

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We have a physician who will soon begin operating with two assistant surgeons on hand and, in certain instances, we will be billing for them both for the same operative session. Their charges will both be billed with an 'AS' modifier due to credentials (PA/CRNP) for the same date and on separate claims. I have seen numerous claims deny because the insurance company could not recognize the difference between the surgeon and the assistant surgeon charges/claims (even when billed with the appropriate modifier 'AS'); they will deny the claim as "duplicate" or the assistant surgeon will be paid at the surgeon's rate causing an overpayment. I fear that they will outright deny one of the assistant surgeon's claims as "duplicate" and it will be a fight to get them to recognize that there were indeed two separate assistant surgeons for the same date of service, which required them to be billed separately on two different claims.

My question is: has anyone billed charges such as these and what has been your experience? Any suggestions would be great as well.
 

haraml7

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Are you putting a supervising physician on the claim for the assistant surgeon? Most insurance companies now pay electronically and if the claim comes through their system (electronically) as the supervising physician(primary surgeon) showing up as the rendering provider, even if the AS modifier is on the claim, that PAs claim WILL pay as the supervising physician (surgeon). I would look at both claims, side by side, and go into your claim form electronically (how does your clearinghouse send the claim) and see how it goes out to the insurance company for the rendering provider for both claims.

I had this issue a lot of the time due to the way the claim is sent to the insurance company by the clearinghouse. For example, Cigna would always deny our claims because our EHR system was sending the claim electronically as the supervising physician (surgeon), on the assistant surgeons claim, as the rendering physician even if the AS mod was on the claim. That is probably why there is duplicate denial. Your assistant surgeons claim may be sent showing the rendering physician as the primary surgeon instead of the assistant surgeon.

I would suggest that the primary surgeon has his claim, and the assistant surgeon (AS) should be the rendering physician for his claim, and if a supervising physician "checkbox" is required the Assistant Surgeons' name should go in the supervising box as well. I would not put the primary surgeons' name on the assistant surgeons claim at all. Only because the insurance company will see that the primary surgeon WAS the supervising physician as they both have the same claim, on the same DOS doing the same surgery. So there is no need to tell the insurance company again on the assistant surgeons claim that there is a supervising physician.

Please contact me if you have any more questions.
Thanks
 
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