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What do you think?

  1. #1
    Default What do you think?
    Medical Coding Books
    Doctor A is not creditialed yet with a commerical insurance. Doctor A performs the surgery with Doctor B assisting. Doctor B bills the insurance with no mention of doctor A on the hcfa. The op report lists doctor A as the surgeon and doctor B as the assistant. My gut tells me this is wrong. What do you think?

  2. #2
    Location
    Columbia, MO
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    12,531
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    It IS wrong

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
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    Quote Originally Posted by julia9723 View Post
    Doctor A is not creditialed yet with a commerical insurance. Doctor A performs the surgery with Doctor B assisting. Doctor B bills the insurance with no mention of doctor A on the hcfa. The op report lists doctor A as the surgeon and doctor B as the assistant. My gut tells me this is wrong. What do you think?
    Did doctor B bille CPT's without AS or 80 modifier?

  4. #4
    Default
    doctor B did not bill 80. He billed as the primary surgeon with no assistant.

  5. #5
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    Quote Originally Posted by julia9723 View Post
    doctor B did not bill 80. He billed as the primary surgeon with no assistant.
    Well it 100% wrong beceause Per Op reprot Doc B was an assistant so he should have used modifier 80 and not bill as a primary doc.

  6. #6
    Location
    Columbia, MO
    Posts
    12,531
    Default
    It is wrong for many reasons. First it is a false claim, second credentialing is the whim of the payer. If the surgeon was not credentialed then this needed to be explained to the patient prior to surgery so the patient could accept or decline the out of network status of the surgeon. There are many reasons a payer May not credential a provider and he cannot be disguised as a different provider for payment

    Debra A. Mitchell, MSPH, CPC-H

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