Ob-Gyn Coding Alert

Question: What are the ramifications of hiring a surgical assistant as a full-time employee and billing her services as "incident to" under Medicare guidelines?

Massachusetts Subscriber

Answer: Because many payers, including Medicare, will not reimburse for a surgical assistant unless she bills  under her own provider number -- and only MDs can obtain a provider number -- this is a reimbursement challenge. Billing for the assistant's fees under the physician's provider number is considered fraudulent unless a private carrier instructs you to bill in that manner.  

But Medicare and many private carriers will pay for a physician to serve as the surgical assistant using modifier -80 (assistant surgeon) or modifier -82 (assistant surgeon [when qualified resident surgeon not available]), and will also pay for a physician's assistant to serve as a surgical assistant using modifier -AS (physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery). These are the only circumstances under which they will reimburse for a surgical assistant's services. The "incident to" rule applies only to office or outpatient services, not to inpatient surgical services. Therefore, it is not an option even if the surgical assistant is an employee of the practice.