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Assistant Surgery billing as Primary surgeon

  1. #1
    Default Assistant Surgery billing as Primary surgeon
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    Ok group-
    I probably already know the answer to this, but need clarification and possible documented support on this. Phys. B (ENT) assists Phys A (Oral surgeon). Phys A performs a Caldwell-Luc while Phys. B performs a nasal antrostomy. The CPT for the nasal is 31256 but is NOT a payable assistant surgeon code. Can the physician bill this code as a primary surgeon and if so what modifier should be used? And should he dictate his own operative report?

    If he cannot bill this code as primary, then how can he bill this?

    Thanks

  2. #2
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    Quote Originally Posted by misbell View Post
    Ok group-
    I probably already know the answer to this, but need clarification and possible documented support on this. Phys. B (ENT) assists Phys A (Oral surgeon). Phys A performs a Caldwell-Luc while Phys. B performs a nasal antrostomy. The CPT for the nasal is 31256 but is NOT a payable assistant surgeon code. Can the physician bill this code as a primary surgeon and if so what modifier should be used? And should he dictate his own operative report?

    If he cannot bill this code as primary, then how can he bill this?

    Thanks
    well if they are both MD's and performing two different procedures they it could be billed with modifier 62-Two surgeons.

  3. #3
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    Well, the primary surgeon op report indicates Phys B as the assistant and I don't think -62 is appropriate because both physcians would have to code the same CPT codes with the modifier. Also, CPT 31256 is not a payable co-assistant charge.

  4. #4
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    Quote Originally Posted by misbell View Post
    Ok group-
    I probably already know the answer to this, but need clarification and possible documented support on this. Phys. B (ENT) assists Phys A (Oral surgeon). Phys A performs a Caldwell-Luc while Phys. B performs a nasal antrostomy. The CPT for the nasal is 31256 but is NOT a payable assistant surgeon code. Can the physician bill this code as a primary surgeon and if so what modifier should be used? And should he dictate his own operative report?

    If he cannot bill this code as primary, then how can he bill this?

    Thanks
    Physician B will bill the 31256 as the primary surgeon and needs to dictate an op report for that procedure.
    Physcian A will bill the Caldwell-Luc as the primary surgeon and will dictate the op report for that procedure.
    No modifier is needed on either of those codes.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

  5. #5
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    Tacoma, WA
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    Quote Originally Posted by misbell View Post
    Well, the primary surgeon op report indicates Phys B as the assistant and I don't think -62 is appropriate because both physcians would have to code the same CPT codes with the modifier. Also, CPT 31256 is not a payable co-assistant charge.
    If the code Physician A is using allows an assistant, then Physician B can bill as assistant on that procedure with a modifier 80, and then bill the other procedure as the primary surgeon. This is done all the time with two surgeons who are of different specialties.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

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