Assistant Surgeons in CPT Coding Questions Forum

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Assistant Surgeons

Author	Comment
Jan1952	Assistant Surgeons	Lead	[-]
Posts: 4 Sep 28 06 6:19 AM Reply Quote More My Recent Posts	Tags : None My physicians often use an assistant surgeon with some complex spine cases. The assistant surgeon's office insists that they must bill the same exact fees as the primary surgeon. They insist I give them my fee schedule so they can bill the same amount. Is there any protocol when assitant surgeons or 2 surgeons are billing. Shouldn't each surgeon bill thier regular fee shedule thanks for your help
Steve Verno	Re: Assistant Surgeons	#1	[-]
Posts: 10220 Sep 28 06 7:42 AM Registered User Reply Quote More My Recent Posts	The assistant surgeons should be using their own fees. They cannot ask you for your fees as this would be considered as price fixing and a violation of Federal law.
L8barbara	Re: Assistant Surgeons	#2	[-]
Posts: 1316 Sep 28 06 11:52 AM Reply Quote More My Recent Posts	How are the assistant surgeons suppose to bill 25% of the surgeon's fee if they don't know what the surgeon is charging? All assists that I've ever seen have requested the CPT, ICD, charges and IP /OP status. If the patient's insurance doesn't pay or it is a self pay uninsured patient - what would you charge the patient for the assistant? barbara
NaGahl	Re: Assistant Surgeons	#3	[-]
Posts: 1724 Sep 28 06 5:32 PM Reply Quote More My Recent Posts	You'd have a very hard time passing that off as "price fixing." For an assist, I charge a % of the assistant's standard fee for that procedure. It doesn't matter to me whatsoever what the primary surgeon's fee is. The truth is that whatever the insurance company allows for the assist won't exceed my charge anyway. Even if it does, I'm not entitled to charge more than my standard fee just because the primary does. A physician's fees should be set at what's reasonable, not necessarily at what's possible.
Steve Verno	Re: Assistant Surgeons	#4	[-]
Posts: 10220 Sep 28 06 11:40 PM Registered User Reply Quote More My Recent Posts	If I see the original surgeon's claims and the assistant surgeon's claims, and both are charging the same fee, as an inspector, I will be asking staff from both sides many questions and eventually the truth will come out.
afp2005	Re: Assistant Surgeons	#5	[-]
Posts: 67 Oct 3 06 12:29 PM Reply Quote More My Recent Posts	Assistants are paid at a certain percentage of an approved charge which is dependent on your contracted rate or the Medicare approved rate. It really doesn't matter what you charge as long as you have either modifier 80 or 82 attached to the CPT code in the 1st modifier position. Personally I get a copy of the HCFA1500 form from the surgeon so I know what he billed. If there is a discrepancy in how and what he billed vs what how I believe it should be billed, I would discuss it with the primary surgeon. If the codes used for the assistant surgeon and primary surgeon do not match, then (in my experience) do not get paid and are what are flagged for explanations. I typically bill what the surgeon bills and attach either modifier 80 or 82. The insurance company is who sets the price. It doesn't matter what is sent in. In my opinion, this would be no different than submitting the full charge on the 2nd procedure instead of applying the 50% reduction for multiple surgeries. I don't do it then and therefore I wouldn't do it on the assistant surgeon bill. I have never had an instance in 29 years where an insurance company complained that I billed the same fees as the primary surgeon nor have they ever paid me as a primary surgeon. And yes, in the past I was an auditor case manager for an insurance company investigating claims. Vicki, RN, MSN, Consultant
L8barbara	Re: Assistant Surgeons	#6	[-]
Posts: 1316 Oct 4 06 6:08 AM Reply Quote More My Recent Posts	Thank you Vicki. I'd appreciate your (further) input on billing un-insured patients; Do you bill them a percentage? What percentage ? Is it figured on the surgeon's total fee? or The assistant's own fee schedule? TIA barbara
aleaver	Re: Assistant Surgeons	#7	[-]
Posts: 1081 Oct 4 06 8:06 AM Reply Quote More My Recent Posts	Personally, I would not charge the same rate as the surgeon because I have seen problems in other practices. The insurance carrier leaves off or ignores the 80 or 82 modifier then denies claim stating performed by another physician. It's a pain the butt to get fixed and appeals are involved, etc. We always charged 25% of the surgeon's fees both to insurance and the non-insured patient. April
afp2005	Re: Assistant Surgeons	#8	[-]
Posts: 67 Oct 4 06 2:04 PM Reply Quote More My Recent Posts	Barbara: *Quote:* I'd appreciate your (further) input on billing un-insured patients; Do you bill them a percentage? What percentage ? I never bill even an uninsured patient anything lower than what I would bill Medicare. So first I would take a look if this is a Medicare payable code for an assistant surgeon. If it is, then I would take my Medicare fee schedule and take the Medicare approved assistant surgeon percentage. For IL and WPS (our Medicare carrier), the fee is 16% of the Medicare allowed rate for that particular covered code. If it is not a Medicare payable code, I wouldn't bill anything. *Quote:* Is it figured on the surgeon's total fee? or The assistant's own fee schedule? Usually I have found it is based on the assistant's own fee schedule. I actually had something strange happen once....the assistant surgeon had a better fee schedule than the surgeon and was paid at 30% of the approved rate of his fee schedule. The surgeon had signed up with a silent PPO and was priced accordingly to his fee schedule and received LESS than the assistant surgeon. This is why it is so important in contracting that one does not allow an insurance company to resell it's product AND never to sign a contract that they don't know what they are signing. For example, one of my insurance contracts is for 50% of the surgeon's fees for the assistant surgeon, AND the multiple surgery rules do not apply. I receive full price for each and every code.

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