General Surgery Coding Alert

Question: Our office employs a RN who assists our surgeon with surgical procedures. She has just completed her RNFA certification. How should we report her services? Arizona Subscriber Answer: The answer depends on the insurer, but in most cases you cannot bill. A registered nurse/first assistant (RNFA) is a registered nurse (RN) who has undergone additional training, available through the National Surgical Assistant Association, to serve as a surgical first assistant. Medicare and most public aid programs will not pay for an RNFA. And an RNFA is not licensed to practice medicine and may not perform any services independent of the physician as a nurse practitioner or physician's assistant may.

Private payers who reimburse RNFA services may require that modifier -81 (Minimum assistant surgeon) be appended to the appropriate procedure code(s), although some will allow higher payment with modifier -80 (Assistant surgeon). Other private payers may accept HCPCS modifier -AS (Physician assistant, nurse practitioner or clinical nurse specialist services for assistant at surgery).

Because RNFAs have no universal provider identification number (UPIN), you will have to ask the individual insurer how to identify them on the claim form. Usually, the RNFA will use the physician's UPIN (which can make it appear as if the physician assisted him- or herself) or a "generic" UPIN, such as "RNFA01."