decisionhealth Newsletters, Part B News - 2011 Issue 12 (December)
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Article Overview
This Q&A article explains general coverage of billing and reporting issues for bilateral orthopedic procedures when a physician assistant or other non-physician provider is involved. It discusses how payer requirements can differ between Medicare and commercial carriers, and it highlights the types of claim-format and assistant-at-surgery guidance that practices should verify before submitting claims.
Why This Topic Matters
Practices that bill bilateral procedures with assistant-at-surgery involvement can face claim processing differences across payers. This article helps readers understand the scope of the issue and the kinds of payer-specific rules they need to confirm.
Article Sections
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Expert Q&A on bilateral procedure reporting for non-physician providers
A billing question is presented and answered in a practical claim-reporting context. The discussion centers on payer variation, assistant-at-surgery reporting, and how bilateral procedure claims may be formatted.
What You Will Learn
- How payer policies can affect reporting of bilateral procedures involving a non-physician provider
- What general claim-format issues should be checked for assistant-at-surgery billing
- Why Medicare and commercial payer requirements may differ for this type of service
- Which broad reporting topics should be verified with carriers before billing
Who Should Read This
- Physician assistants
- Billing staff
- Coding professionals
- Practice managers
- Orthopedic surgery practices
Codes Discussed
Modifiers Discussed
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