Medical Billing Forum

General Category => General Questions => Topic started by: kimsmith1967 on September 02, 2009, 11:56:09 PM

Title: Assistant at Surgery
Post by: kimsmith1967 on September 02, 2009, 11:56:09 PM
I do the billing for an RNFA and she does alot of knee scopes and her claims get denied.  At one time there was a letter that an assistant was needed for this px but I am unable to locate it.  Is any one familiar with what I am talking about or how I can get a copy of this letter so I can submit with my appeals.  thanks for your help

Kim
Title: Re: Assistant at Surgery
Post by: PMRNC on September 03, 2009, 06:16:47 AM
Appeal letters are not standard so I'm not sure what you are looking to copy?  You should appeal based on the denial
Was the provider working UNAssisted when they should have been assisted? Or did the facility require an assistant to which your provider did the assisting? If so they should be able to provide you with the documentation saying the assistant was required. You don't really say why the claims were denied and to do an appeal that's where you need to begin.
Title: Re: Assistant at Surgery
Post by: kimsmith1967 on September 03, 2009, 03:31:50 PM
the claims are being denied due to insurance company stating an assistant is not needed for the px I have the op report that shows the dr needed an assistant but the letter I am asking about is a letter that shows that an assistant is needed for px   at one time I had one but I am not able to locate it now


Kim
Title: Re: Assistant at Surgery
Post by: PMRNC on September 03, 2009, 09:41:05 PM
Just state that per the attached op report an assistant was needed. In some cases some hospitals REQUIRE an assistant and in that case you could re-use the same letter. If the hospital requires an assistant for that particular procedure you wouldn't even need the op report.
Title: Re: Assistant at Surgery
Post by: deloga on September 04, 2009, 06:47:01 PM
Hi,

I bill for PA's as assistant surgeons and I use the Modifier AS, Not 80... And some claims do get paid and some do not.  I do not have a sample letter for as each case is different.

Using the Fee Schedule on Trailblazerhealth.com there is determination area for the need of assistant surgeons.

A lot of appeals are done fighting for their payment, even with the documentation some payers will not pay.Best of luck.

Have a Super Weekend!
Dee  
Title: Re: Assistant at Surgery
Post by: PMRNC on September 05, 2009, 09:23:45 AM
PA's are different story, but if a surgeon uses an assistant and the hospital REQUIRES an assistant for that procedure the carrier has to cover it so long as they cover the surgery.