MO HealthNet Internet Provider Training Program Presented by

MO HealthNet Internet Provider Training Program Presented by

MO HealthNet Internet Provider Training Program Presented by the Provider Education Unit MO HealthNet Division MO HealthNet Division 1 ASSISTANT SURGEONS AND RELATED POST-OPERATIVE CARE

Presented by the Provider Education Unit MO HealthNet Division MO HealthNet Division 2 Information regarding assistant surgeons can be found in Section 13.41 of the Physician Provider Manual. To access the manual go to the MHD Public Web site: www.dss.mo.gov/mhd/providers/index.htm.

In the left hand column, scroll down and click on Provider Manuals. MO HealthNet Division 3 The services of an assistant surgeon are billed with modifier 80. Only one assistant surgeon can be paid for those procedures that warrant an assistant. An assistant surgeons fee is reimbursable at

20% of the surgeons fee for the surgical procedure. MO HealthNet Division 4 The services of an assistant surgeon are billed with modifier 80. Only one assistant surgeon can be paid for those procedures that warrant an assistant. An assistant surgeons fee is reimbursable at

20% of the surgeons fee for the surgical procedure. MO HealthNet Division 5 The services of an assistant surgeon are billed with modifier 80. Only one assistant surgeon can be paid for those procedures that warrant an assistant. An assistant surgeons fee is reimbursable at

20% of the surgeons fee for the surgical procedure. MO HealthNet Division 6 If the surgeons claim is systematically priced, the assistant surgeons claim is also systematically priced. If the surgeons claim is manually priced, the assistant surgeons claim is also manually priced,

and an operative report must be attached to the paper claim for payment. MO HealthNet Division 7 If the surgeons claim is systematically priced, the assistant surgeons claim is also systemically priced. If the surgeons claim is manually priced, the assistant surgeons claim is also manually priced, and an operative report must be attached to the

paper claim for reimbursement. MO HealthNet Division 8 MO HealthNet does not reimburse for the services of an assistant surgeon when a cosurgeon is used. MO HealthNet Division 9

Registered nurses and other non-physician personnel are ancillary staff and not considered assistant surgeons or assistants at surgeryand services performed by them are, therefore, not billable to MO HealthNet as a separate service. MO HealthNet Division 10

Follow-up care provided by the assistant surgeon is subject to the 30-day postoperative policy as described in Section 13.41 of the Physician Manual. MO HealthNet Division 11 Postoperative Care Postoperative care includes 30 days of routine

follow-up for those surgical or diagnostic procedures having a MO HealthNet reimbursement amount of $75.00 or more. For counting purposes, the date of surgery is the first day. MO HealthNet Division 12 Postoperative Care (continued) This policy applies whether the procedure

was performed in the hospital, ambulatory surgical center or an office setting, and applies to subsequent physician visits. Pain management is considered part of postoperative care. Visits for the purpose of postoperative pain control are not separately reimbursable. MO HealthNet Division 13 Postoperative Care (continued)

This policy applies whether the procedure was performed in the hospital, ambulatory surgical center or an office setting, and applies to subsequent physician visits. Pain management is considered part of postoperative care. Visits for the purpose of postoperative pain control are not separately reimbursable. MO HealthNet Division 14

Postoperative Care (continued) Supplies necessary for providing the follow-up care in the office, such as splints, casts and surgical dressings in connection with covered surgical procedures that meet the postoperative care policy, may be billed under the appropriate supply code. Attach an invoice if applicable. MO HealthNet Division 15

Exceptions to Post-operative Care Services that are exceptions to the postoperative care policy may be reimbursed for complications or extenuating circumstances that have been documented and determined to be exempt by the state medical consultant. In addition, the following services are exempt from the postoperative policy limitations: MO HealthNet Division 16

Exceptions to Post-operative Care (continued) Exceptions to the postoperative care policy may be reimbursed for complications or extenuating circumstances that have been documented and determined to be exempt by the state medical consultant. In addition, the following services are exempt from the postoperative policy limitations: MO HealthNet Division

17 Exceptions to Post-operative Care (continued) Initial hospital visits to allow payment for physician services when a patient is admitted to the hospital on the same day of service as a surgery. Consultations Renal dialysis codes. Physician services provided prior to the date

of surgery. MO HealthNet Division 18 Exceptions to Post-operative Care (continued) Initial Hospital visits to allow payment for physician services when a patient is admitted to the hospital on the same day of service as a surgery. Consultations.

Renal dialysis codes. Physician services provided prior to the date of surgery. MO HealthNet Division 19 Exceptions to Post-operative Care (continued) Initial Hospital visits to allow payment for physician services when a patient is admitted to the hospital on the same day of service as a

surgery. Consultations. Renal dialysis codes. Physician services provided prior to the date of surgery. MO HealthNet Division 20 Exceptions to Post-operative Care (continued) Initial Hospital visits to allow payment for

physician services when a patient is admitted to the hospital on the same day of service as a surgery. Consultations. Renal dialysis codes. Physician services provided prior to the date of surgery. MO HealthNet Division 21 Exceptions to Post-operative Care

(continued) All surgeries or procedures billed having a reimbursement amount of less than $75.00. Newborn care. Suture removal. MO HealthNet Division 22 Exceptions to Post-operative Care (continued)

All surgeries or procedures billed having a reimbursement amount of less than $75.00. Newborn care. Suture removal. MO HealthNet Division 23 Exceptions to Post-operative Care (continued) All surgeries or procedures billed having a

reimbursement amount of less than $75.00. Newborn care. Suture removal. MO HealthNet Division 24 The surgeon and assistant surgeon must each submit separate professional claims for services provided, using his/her individual NPI.

A clinic may submit a single professional claim using the clinics NPI and must indicate each individual providers NPI as the performing provider. MO HealthNet Division 25 The surgeon and assistant surgeon must each submit separate professional claims for services provided, using his/her

individual NPI. A clinic may submit a single professional claim using the clinics NPI and must indicate each individual providers NPI as the performing provider. MO HealthNet Division 26 For assisting at cesarean deliveries, the appropriate CPT procedure code for

instance, procedure code 59514, for the delivery only must be billed, regardless of whether or not the surgeon billed the global procedure. A Global delivery indicates that the prenatal care, delivery and postpartum care are provided by a single physician or private medical clinic/group. MO HealthNet Division 27

Thank you again for participating in this training session. If you have questions regarding the information in this presentation, please contact the Provider Education Unit at 573751-6683. MO HealthNet Division 28

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