Ob-Gyn Coding Alert

As a follow-up to our March article on coding for more than one surgeon, this article will assist the growing number of ob/gyn practices using or contemplating the use of nurse practitioners (NP), certified nurse midwives (CNM) or physician assistants (PA) to provide first assists in surgery. First assist is a term describing the person who provides immediate assistance to a surgeon during a case that requires an extra, trained and qualified set of hands. This article will clarify the issues and direct the ob-gyn coder toward tactics that will maximize reimbursement.

Will Carriers Pay for Mid-level Providers
Who Assist in Surgeries?

In the course of researching this article, we discovered that many ob/gyn practices (including physicians, managers, coders and mid-levels) are confused about whether an NP, PA or CNM can be paid for first assists. Many see the mid-level surgical assistant as part of the physicians cost. But Catherine A. Brink, CMM, CPC, president of Healthcare Resource Management, Inc., says, Yes, in many cases a mid-level provider can be paid in addition to the physician. However, certain conditions must be met.

First, the surgical procedure has to be one that allows for a professional assistant. While there is no national listing of CPT codes that allow for assists, Brink says that Medicare carriers in many states have such lists in their manuals. If no such listing is found, your only choice is to check with the payer ahead of time or bill the service and see what happens, according to Brink. Many commercial carries have a list of procedures that they do not believe merit assists.

Secondly, the mid-level providing the assist must meet the credentialing criteria of the state in which they work. According to Karen S. Fennell, RN, MS, senior policy analyst for the American College of Nurse-Midwives, these laws and regulations vary greatly across the states and among the different kinds of mid-levels. However, Fennell says that in most places nurse-midwives are fully credentialed and allowed to practice and code as physicians. The various local professional associations for the different mid-levels can be a good source of information about regulations and reimbursement. You can check with the local chapter of the American College of Midwives in your area.

Beyond meeting regulatory criteria, Brink points out that the mid-level provider must also have privileges to practice at the hospital or surgical center when the surgery is being performed.

Finally, in order to bill for mid-level services, the mid-level professional must have an individual provider number for the carrier that will be paying. Because these services will be billed as professional services and not incident to, the physicians identification number will not work. Even if the physician and [...]