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.
 

csperoni

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From my experience, you cannot get paid for 2 assistant surgeons. In my practice, if there are multiple assists, whoever did at least 51% of the assist work is who is billed.
Regarding -AS, most carriers want it billed with the PA/NP name, on a separate claim from the physician. I have had 1 carrier insist that we must bill 1 claim with the MD name, -AS, and then pay at 120%. I know, it makes no sense, but many carriers create their own rules that you must follow in order to get payment.
 

clark.amy86

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From my experience, you cannot get paid for 2 assistant surgeons. In my practice, if there are multiple assists, whoever did at least 51% of the assist work is who is billed.
Regarding -AS, most carriers want it billed with the PA/NP name, on a separate claim from the physician. I have had 1 carrier insist that we must bill 1 claim with the MD name, -AS, and then pay at 120%. I know, it makes no sense, but many carriers create their own rules that you must follow in order to get payment.
Thank you so much for your input, I appreciate it!
 
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