# Modifier AS + 80/81/82?



## Lisa Bledsoe (Jan 25, 2012)

This is a new one to me.  One of our A/R reps was informed by a rep at Noridian that we are required to add mod 80/81/82 as well as AS for PA assists effective 10/1/11.  I cannot find any publication notifying us of this new requirement.  Does anyone have a CMS link or even better, one for Noridian?
TIA!!


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## LLovett (Jan 25, 2012)

This is actually not new. We have had to do this for several years. I am in Michigan so we have WPS Medicare.

https://www.cms.gov/manuals/downloads/clm104c12.pdf

110.3 - PA Billing to Carrier
(Rev. 1, 10-01-03)
B3-16001, B3-15044, B3-2156, PM-B-99-16
A. Modifiers
Physician Assistant as assistant at surgery should be identified with a modifier AS.
Billers must identify PA assistant-at-surgery services with the following modifiers as applicable:
Assistant surgeon services billed with modifier “-80”;
Minimum assistant surgeon services with modifier “-81”;
Assistant surgeon services (when assistant resident surgeon not available) with modifier 82.
NOTE: 80, 81, and 82 are paid at 65 percent of 16 percent. No other reductions for minimum services take place.

This is on page 172 of the manual. 

Laura, CPC, CPMA, CEMC


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## Lisa Bledsoe (Jan 25, 2012)

I see it in the manual; but have never been instructed to do this for Trailblazer or Noridian...until today.


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## kjstearns (Jan 25, 2012)

Lisa,

I was just told the same thing today. Our billing office told me that they called Medicare several times to confirm and were told that it has been in their online manual for some time but they are just now starting to enforce it. I wish I would have known this sooner!

~Kirsten, CPC


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## Lisa Bledsoe (Jan 25, 2012)

In our office, the question has now come up as to whether or not the manual is being interpreted correctly.  There is a MLN article that specifically applies this scenario to Method II CAH's where the PA has reassigned his/her billing rights to the hospital.  Our PA's have not done this; so if we start adding another modifier it is going to change the reimbursement they receive as well.  Any other thoughts?


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## Lisa Bledsoe (Jan 31, 2012)

*Clarification from Noridian*

We received this update today:
https://www.noridianmedicare.com/cg...n&tmpl=part_b_viewnews&style=part_ab_viewnews


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## pkidd (Feb 2, 2012)

*Modifiers AS + 80-81-82*

Greetings!

Our practice has just learned about this 'new" rule also.  We, too, are Noridian.

We have only appended modifier-AS when our PA-C assisted the surgeon.

Our question now is -- In which order should the modifiers be written?
My inclination is 80-AS, but our home office is insisting that it should be AS-80 and I'm not so sure about that.

How are you all submitting the claims?   If I can find a reference or CMS documentation, that would be great.  

I appreciate your "assist"ance!
Pat Kidd, CPC, CGSC
Albany Surgical Associates
Albany, OR
pkidd@samhealth.org


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## Jaimee (May 16, 2012)

We just got a new PA-C at the end of December, and it has taken Cahaba Medicare until May to complete his credentialing. I am getting paid when I use just AS modifier, but, when I use another modifer, say 59, and use the coding rule that states numerical before alphabetical, those codes get denied for invalid use of modifier.. I can't find a publication that says the rule has changed for 2012......


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## armen (May 17, 2012)

Jaimee said:


> We just got a new PA-C at the end of December, and it has taken Cahaba Medicare until May to complete his credentialing. I am getting paid when I use just AS modifier, but, when I use another modifer, say 59, and use the coding rule that states numerical before alphabetical, those codes get denied for invalid use of modifier.. I can't find a publication that says the rule has changed for 2012......



We are submitting claims with just AS modifier. I was trying to find something about this new rule on Cahaba's website but could not find it.


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## Jaimee (May 17, 2012)

armen said:


> We are submitting claims with just AS modifier. I was trying to find something about this new rule on Cahaba's website but could not find it.



I searched and could not find anything either, but the CSR kept telling me to "pay close attention to the order of the modifiers" so all of my claims that have 2 modifiers I am rebilling to see how they process...


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## mcpalmeter (May 17, 2012)

*Multiple Modifiers*

Hi,

I am not familiar with the "coding rule" about numerical before alphabetical.  I have found that the modifier that more directly impacts reimbursement should be listed first.  In your case, the AS modifier would be listed first as it impacts the rate of reimbursement.  The 59modifier would denote a decision to pay or not to pay but not the rate of payment.

Just my 2 cents.


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## armen (May 17, 2012)

Jaimee said:


> I searched and could not find anything either, but the CSR kept telling me to "pay close attention to the order of the modifiers" so all of my claims that have 2 modifiers I am rebilling to see how they process...



All of our claims have AS and then all other modifiers. email me if you have any questions : aayrapetyan@perimeterortho.com


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## MandyFlagg (Jun 5, 2012)

*WPS guidelines*

I see the guidelines stating to use both of these, CMS states as applicable, but if you reference WPS guidance on this it sounds like they only want the 80, 81, or 82 used if a physician (MD) is the assistant.  The articles I am referencing are:

http://www.wpsmedicare.com/part_b/publications/news/archived/2012-0130-modifier-as-npp.shtml

and

http://www.wpsmedicare.com/part_b/resources/modifiers/modifier-assist-surg.shtml


Any thoughts?


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## aaron.lucas (Jun 5, 2012)

That's because AS is only for non-physician assistants, and would only be used by PA, SA, RN, etc.  What I dont understand is why they want people to use both.  80/81/82 are for physicians only, and AS is for non-physicians, so by appending both you're implying that the provider is both, which is impossible, either you're a doctor or you're not... anybody else peeved about this?


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## gost (Jun 5, 2012)

I can't find anything that says 80, 81 & 82 are for physicians only.  I suspect the reasoning is in the detail provided by -80, 81 & 82.  -AS does not offer minimum assistant or qualified resident n/a options.


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## JMeggett (Jun 5, 2012)

I'm in Washington, so Noridian is our Medicare provider.  In the IOM online Medicare Claims Processing Manual, Publication 100-04, Chapter 12, Section 110.3 - Posted 01/30/12 there is a Mediare Part B Bulletin titled "Physician Assistants Properly Billing Assistant-At-Surgery Services".   It states to put the -AS first, then -80 or -81 or -82.  It also talks about how these will be reimbursed..."Physican Assistant assistant-at-surgery services are paid at 85% of 16% of what a physician is paid under the Medicare Physican Fee Schedule".   
I've actually forgotten to add the -80 after the -AS and sure enough...the claim was denied.  This is all new to Noridian as of beginning of 2012, last year the policy for PA-C assistant at surgery was just to use -AS.  At least here in Washington that's how we were told to bill by customer service at Medicare. 
Jenna


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## Donna T (Jun 6, 2012)

We always billed out our PA's as AS82 and we were paid accordingly.  I've billed this way since 1997 and never had an issue.


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