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Coding for a PA as an assist and getting paid!

  1. #1
    Default Coding for a PA as an assist and getting paid!
    Medical Coding Books
    I work for an Ortho Doc that uses a registered PA for all his surgeries as the assist. We bill for him with an 80 mod but they always get denied and when I appeal along with the op-report we will get paid sometimes and sometimes not. Does anyone know why that is?

  2. #2
    Location
    Greeley, Colorado
    Posts
    2,045
    Default
    You should be using modifier AS.
    Lisa Bledsoe, CPC, CPMA

  3. #3
    Location
    North Carolina
    Posts
    3,126
    Default
    AS modifier is used for PA assists (most carriers)

    http://www.aaos.org/news/bulletin/ma...managing14.asp

  4. #4
    Default
    Thank you for your replies. I have tried to bill with the AS mod also but they still deny even on appeal. Even with the Dr stating the necessity of an assist. Did not know if anyone has experience with PA's and if it is just some carriers will pay and others don't?

  5. #5
    Location
    North Carolina
    Posts
    3,126
    Default
    Our practice has surgeons and PA assists. Some procedures do not warrant the need of an assistant.

    This link will indicate if a procedure warrants an assistant.

    http://www.cms.hhs.gov/pfslookup/02_...es&next=Accept

    click on Single HCPC Code

    click on Payment Policy Indicatiors

    click “next”

    click “next”

    enter your CPT code in the “HCPC” box

    select your drop down key in the “modifier” box and select “all modifiers”

    click “submit”

    In the "ASST Surg" column-

    0=payable with documentation of medical necessity
    1-not payable
    2=Assist payable
    Last edited by RebeccaWoodward*; 03-13-2009 at 10:18 AM.

  6. #6
    Location
    Chesapeake
    Posts
    34
    Smile
    I work for an ortho practice as well. You will find that some carriers will pay an assistant charge and some will not. Good luck
    Jill M. Grier CPC
    2016 New Membership Development Officer
    Professional Coders of Tidewater
    Chesapeake, VA

  7. #7
    Default
    Thank you for that link Rebecca. It is very helpful. I appreciate all of your comments.

  8. #8
    Location
    ENGLEWOOD/DENVER
    Posts
    2,338
    Default
    Most carrier's have a list that you can obtain that will tell you which procedure that an assist payment is allowed for (including Medicare). I would recommend thatyou obtain these and use these for purposes of denials if needed.

    I recently gave my docs a list of procedures that are not covered by 90% of the payors. They use our PA's for even the simplist cases, cause they want the PA's to do the suturing. I told them to stop being lazy and do it themself They hate when they see memo's from me..they know its going to require more work for them!

    hope this helps shed some light
    Mary,CPC,COSC

  9. #9
    Default
    Yes, that is the way with my Dr. He uses the PA for every surgery. Thank you!

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