Results 1 to 3 of 3

Pa opnote documentation

  1. Default Pa opnote documentation
    Exam Training Packages
    I just read a bunch of previous questions regarding PA opnote documentation questions, however, I am still confused.

    We hired a PA several months ago and reimbursement has been an issue. When I review the coding edits and the assist is a "1". I seem to be getting denials on each procedure with a "1". Should we not have the PA assist on these cases? OR --- should we appeal these procedures? If the answer is yes how do I appeal the procedures if the docs do not document the reason for the PA being in on the case.

    We have a meeting coming up and it would be great if someone could direct me to a source that details what the documentation requirements are for PA assists.

    Would really appreciate your assistance!!!

    Thanks

    Denise

  2. #2
    Location
    San Antonio, Tx
    Posts
    73
    Thumbs up
    Here are a couple of links that I believe really break it down.

    http://www2.aaos.org/aaos/archives/b...g06/coding.asp

    http://www.paorthosociety.org/resour...sAssistant.pdf

    Hope this is helpful.
    Good luck!

    Ray
    Ray Galvez CPC

  3. #3
    Location
    North Carolina
    Posts
    3,126
    Default
    Quote Originally Posted by Desperate Denise View Post
    I just read a bunch of previous questions regarding PA opnote documentation questions, however, I am still confused.

    We hired a PA several months ago and reimbursement has been an issue. When I review the coding edits and the assist is a "1". I seem to be getting denials on each procedure with a "1". Should we not have the PA assist on these cases? OR --- should we appeal these procedures? If the answer is yes how do I appeal the procedures if the docs do not document the reason for the PA being in on the case.

    We have a meeting coming up and it would be great if someone could direct me to a source that details what the documentation requirements are for PA assists.

    Would really appreciate your assistance!!!

    Thanks

    Denise
    Per the Medicare Claims Manual...

    0=Payment restriction for assistants at surgery applies to this procedure unless supporting documentation is submitted to establish medical necessity.

    1=Statutory payment restriction for assistants at surgery applies to this procedure. Assistant at surgery may not be paid.

    2=Payment restriction for assistants at surgery does not apply to this procedure. Assistant at surgery may be paid.

    9=Concept does not apply.

    Many carriers follow CMS' assistant surgery policy; however, some carriers such as workers comp may pay differently. If it's clear that the carrier follows CMS's policy, payment indicator 1 is not payable.

    Click the link under "downloads"...Open up the PDF file and scroll down to pages 11-12

    http://www.cms.gov/PhysicianFeeSched...umPerPage=2000
    Last edited by RebeccaWoodward*; 04-26-2010 at 07:59 AM. Reason: added link

Similar Threads

  1. Documentation on correct documentation placement of procedure notes in the EMR
    By ashephard in forum Medical Coding General Discussion
    Replies: 1
    Last Post: 02-25-2014, 04:36 PM
  2. Documentation?????
    By JSHAFER in forum Medical Coding General Discussion
    Replies: 3
    Last Post: 09-21-2010, 07:38 PM
  3. Documentation?????
    By JSHAFER in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 09-21-2010, 09:20 AM
  4. Documentation
    By slindamood in forum E/M
    Replies: 4
    Last Post: 08-31-2010, 06:11 PM
  5. Documentation help
    By cwilno in forum Medical Coding General Discussion
    Replies: 1
    Last Post: 06-22-2010, 12:36 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.