Part B Insider (Multispecialty) Coding Alert

Smart strategy:  Master surgical assistant modifiers

Do you know how to bill for registered nurse first assistant (RNFA) services? Surgical practices are using RNFAs more and more, and knowing the RNFA ropes could become a vital skill.

RNFAs are nurses who are specially trained to assist in surgeries. Unfortunately, Medicare won't allow you to bill for their services separately at all--unless the RNFA is also a nurse practitioner or physician assistant, says Quinten Buechner with ProActive Consultants in Cumberland, WI. Other payors will reimburse an RNFA's services separately, however.

• Check your state's regulations. Some states may recognize RNFAs as separate professionals, similar to NPs or PAs, says Buechner. You should ask your state's health department about the legal status of RNFAs. More and more states are adding RNFAs to the ranks of "midlevel" providers, such as NPs, he adds. 

• Ask your payor about modifiers. The "80" modifier doesn't specify one way or the other, but experts say it's usually used only for physicians who assist at surgery. However, some insurers require the use of this modifier for NPs or PAs because they don't recognize the "AS" modifier.

The "AS" modifier designates a surgical assistant, but its descriptor specifically calls for an NP or PA, Buechner notes. Nevertheless, some insurers may still require you to use the "AS" modifier for RNFAs. Don't use the "AS" modifier unless the insurer specifically asks for it because it indicates the provider was an NP or PA, he cautions.

• Ask for a predetermination from your insurer about whether it covers RNFA services, advises Shelly Briles, certified coder with Orthopedic Center of Southern Illinois. Chances are, though, that your surgeons will want the assistance of your RNFA whether his/her services will be reimbursed separately.