Ob-Gyn Coding Alert

Certified surgical assistants (CSAs) often are employed in the ob/gyn operative setting to offer technical assistance for various procedures. But knowing when to use a CSA is not nearly so challenging as figuring out how to get reimbursed for their services. What is the proper, legal way to compensate the assistants and ensure that your practice receives fair reimbursement?

An assistant at surgery can be a physician, a non-physician health professional (i.e., physicians assistant, nurse practitioner or clinical nurse specialist), or a trained surgical technician who actively assists the physician in charge of the case in performing a procedure. But it is the distinction between these three types of assistants that determines coverage for the service and payment amounts. All payers will reimburse a physician to assist at surgery if the procedure in question warrants, under the payers guidelines, the use of an assistant. Many payers also will reimburse, but at a lower level, the services of non-physician health professionals who act as assistants at surgery. But Medicare and commercial insurers view a CSA or surgical technician very differently.

How Do CSAs Get Paid?

Emily Hill, PA-C, president of Hill & Associates, a physician reimbursement and coding firm in Wilmington, N.C., spells out some of the rules for reimbursement of assistants at surgery, as outlined in the Medicare Carriers Manual.

Payment is made for an assistant at surgery when one or more of the following conditions is met:

1. the medical necessity for an assistant has been demonstrated;

2. the surgery requires an assistant in more than 5 percent of the cases nationally; and

3. the assistance at surgery is performed in a hospital where no approved teaching program has been established.

When billing for an assistant at surgery, the primary surgeon reports the CPT code for the surgery without a modifier, and the assistant surgeon reports the same CPT code with modifier -80 (assistant surgeon) to indicate that he or she was an assistant surgeon. When the surgical assistant is a non-physician practitioner, however, the HCPCS modifier -AS (physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery) is used instead.

Medicare, on the other hand, Hill explains, does not reimburse CSAs because they are not considered accredited providers for services rendered. Most third-party payers also do not recognize these individuals as billable providers, and only a few will reimburse for their services at all, Hill adds.

Limited Methods of Reimbursement

Katie McClure, RHIA, is surgical coder at Southeastern Gynecologic Oncology, an outpatient surgery center with five physicians in Alpharetta, Ga. She says they use a CSA for such surgeries as hysterectomies and cancer debulking procedures. We have had several sources [...]