Wiki Primary surgeon and assistant surgeon billing

[allan1]

Hello all ,
One part of Neurosurgery :
Provider A : Primary surgeon
Provider B : Assistant surgeon

Remaining part of Neurosurgery:
Provider B : Primary surgeon
Provider A : Assistant surgeon

For the above scenario , please help us in billing the claim for the provider A. Shall I bill both primary surgeon CPTs and assistant surgeon CPTs in the same claim or I need to bill in separate claim?

 

[amyjph]

I think it depends on the case and the CPTs and possibly some other things like, are the providers partners from the same practice, and do they want it all billed under one and split on the "back end" or something?
Is any of this a teaching physician scenario?

 

[allan1]

I think it depends on the case and the CPTs and possibly some other things like, are the providers partners from the same practice, and do they want it all billed under one and split on the "back end" or something?
Is any of this a teaching physician scenario?

No , both the providers are not from same practice. They are going to bill separately.
Provider A :
63085
63276
22610-80
22614*3-80
22842-80
61783

Provider : B
63085-80
63276-80
22610
22614*3
22842
61783-80

Now my question for provider A whether I should submit 63085 , 63276 , 61783 in one claim and remaining codes in separate claim or I can submit all the codes in one claim?

 

[amyjph]

1. Okay, so if the providers are not from the same practice, who do you bill for? The other practice would handle theirs. This would require coordination with the other surgeon's group to make sure you are all on the same page for assistant versus primary coding. If they don't have matching coding, for example if they submit all the codes with no modifier like their guy was primary on all, you'll possibly get denied depending on claim timing.
2. Are you talking about two different things, assistant-at-surgery versus co-surgery? Some of those CPT allow 62 modifier if they did co-surgery.
3. The codes look like you have a spine guy and neuro guy assisting one another for distinct parts of the case?
4. My view is you would want to submit one claim for your provider's primary surgeon charges. You would submit a second claim if he was assistant (80). If it is a co-surgery situation I think you "might" be able to do the primary (no mod) and co-surgery (62 mod) on one claim.
5. I can't think of a time when I have mixed assistant at surgery and primary coding on one claim. I am sure it possibly could be done but I think it would be weird and might hit a rejection or denial on the way out.
6. 61783 only allows an assistant with specific documentation that one was needed, btw. Check your CPT codes.

 

[allan1]

1. Okay, so if the providers are not from the same practice, who do you bill for? The other practice would handle theirs. This would require coordination with the other surgeon's group to make sure you are all on the same page for assistant versus primary coding. If they don't have matching coding, for example if they submit all the codes with no modifier like their guy was primary on all, you'll possibly get denied depending on claim timing.
2. Are you talking about two different things, assistant-at-surgery versus co-surgery? Some of those CPT allow 62 modifier if they did co-surgery.
3. The codes look like you have a spine guy and neuro guy assisting one another for distinct parts of the case?
4. My view is you would want to submit one claim for your provider's primary surgeon charges. You would submit a second claim if he was assistant (80). If it is a co-surgery situation I think you "might" be able to do the primary (no mod) and co-surgery (62 mod) on one claim.
5. I can't think of a time when I have mixed assistant at surgery and primary coding on one claim. I am sure it possibly could be done but I think it would be weird and might hit a rejection or denial on the way out.
6. 61783 only allows an assistant with specific documentation that one was needed, btw. Check your CPT codes.

Thank you for your clear response