FW: Error Condition Re: Re: Vaginal Sterilization
From: ainsron (ainsron@sbcglobal.net)
Fri Dec 2 21:46:23 2005
Ronald E. Ainsworth, MD, FACOG
-----Original Message-----
From: ainsron [mailto:ainsron@sbcglobal.net]
Sent: Friday, December 02, 2005 8:10 PM
To: 'ob-gyn-l@obgyn.net'
Subject: Re: Error Condition Re: Re: Vaginal Sterilization
That isn't what I took out of his message. However, you're right, if they
are billing as co-surgeons, that is fraud. It really depends on the
modifiers used. An assistant surgeon normally bills with -80 modifier, he
can charge whatever he likes, but the insurance will normally pay only
15-20% of the primary surgeons fee. Complex procedures with two surgeons
having different skills should be billed with a -62 modifier and highly
complex procedures requiring surgical team would bill with a -66 modifier.
Neither of those applies to routine Gyn procedures, they could apply if a
general surgeon or urologist scrubbed to assist with lymph node dissection,
ureteral procedures, etc.
Ronald E. Ainsworth, MD, FACOG
-----Original Message-----
From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Zachariah
Newton
Sent: Friday, December 02, 2005 7:21 PM
To: Multiple recipients of list OB-GYN-L
Subject: Re: Error Condition Re: Re: Vaginal Sterilization
Ron-
As presented, it is implied that the assisting partner is billing as
co-surgeon, as opposed to billing as assistant surgeon. When 2nd surgeon
brings no unique value added skill to the table with perceived
justification, by CPT definition the appropriate billing is that of
assistant surgeon. You adhere to the rules of the road or you willfully
commit fraud. It is not difficult to sort out.
zbn
--
>----- Original Message -----
From: "ainsron" <ainsron@sbcglobal.net>
To: "Multiple recipients of list OB-GYN-L" <ob-gyn-l@dns.obgyn.net>
Sent: Friday, December 02, 2005 10:08 PM
Subject: Re: Error Condition Re: Re: Vaginal Sterilization
>I think it is great to give the residents experience. On the other hand,
> billing for the assistant surgeon's fee between partners is not considered
> "double billing." It is appropriate to bill for services rendered, it
> wouldn't make any difference to me if it were a partner or a colleague in
> another competing practice.
>
> Ronald E. Ainsworth, MD, FACOG
>
> -----Original Message-----
> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Andrew
> Folley
> Sent: Friday, December 02, 2005 3:02 PM
> To: Multiple recipients of list OB-GYN-L
> Subject: Re: Error Condition Re: Re: Vaginal Sterilization
>
> I am in an 8 person OB-Gyn group. Several of my youjger parters will
> routinely scrub together o all major gyn surgeries including TAH, Vag
> Hysts,
>
> etc and C-sections in spite of the fact that we have a OB-GYN program and
> GYN PA to assist with surgery. Part of the reason is for better quality
> of
> service in the OR etc. But my parters also double bill for this. The one
> surgeon gets full payment and the other one bills for 50% payment. some
> insurance companies pay some apparently do not.
> I have opted not to do this as I enjoy working and teachig the residents
> and
>
> the double billing does not seem quite "right". Anyone else have any
> thoughts on billing for second surgeon?? andy
>
>>From: Scott Oesterling <scottoesterling@sbcglobal.net>
>>Reply-To: ob-gyn-l@obgyn.net
>>To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
>>Subject: Re: Error Condition Re: Re: Vaginal Sterilization
>>Date: Fri, 2 Dec 2005 12:06:12 -0600
>>
>>I do most of my tubals under family PACT. I think they pay like $50 or so
>>for the assistant.
>>However, a good scrub can be an "assistant" - I just pointed it out as a
>>pitfall. If you have a bad scub, then I'd rather do them with the scope.
>>
>>Scott
>>On Dec 2, 2005, at 9:08 AM, ainsron wrote:
>>
>>>Do insurances actually pay for an assistant?
>>>
>>>Ronald E. Ainsworth, MD, FACOG
>>>
>>>-----Original Message-----
>>>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Scott
>>>Oesterling
>>>Sent: Thursday, December 01, 2005 9:20 PM
>>>To: Multiple recipients of list OB-GYN-L
>>>Subject: Re: Error Condition Re: Re: Vaginal Sterilization
>>>
>>>We do perhaps 50 vaginal sterilizations per year.
>>>
>>>I prefer it because:
>>>1. the operative time is fast - 10 to 15 minutes per case. No set up
>>>time for either a laparoscope or a hysteroscope.
>>>
>>>2. The equipment list is simple:
>>>weighted spec, two right angle retractors, two right angle clamps,
>>>extra long smooth pick ups, extra long babcock, a needle driver, tooth
>>>forceps, metz, and mayos
>>>
>>>3. The procedure is less painful that a scope tubal.
>>>
>>>4. You have pathologic confirmation of the sterilization.
>>>
>>>Contraindications:
>>>History of pelvic pain that would benefit by laparoscopy
>>>History of 2 c-sections
>>>Obesity unless you can feel a retroverted uterus in the office
>>>Lack of a skilled assistant
>>>
>>>Disadvantages:
>>>
>>>4 weeks pelvic rest rather that two.
>>>100 mL EBL vs 25 mL
>>>
>>>Always use antibiotics.
>>>
>>>I have had too much bowel fat get in the way with some very fat ladies.
>>> For the obese, I prefer the scope.
>>>
>>>Scott Oesterling
>>>San Mateo Ca.
>>>
>>Scott Oesterling
>>
>
