Wiki AS Modifier - needed documentation

[kristamontes]

Hey! I'm new to this wacky world of billing/coding and I have a question regarding our assists on our surgeries. We only have one Doc in the office and she uses our PA or CNM for assists on her surgeries. We have a new coder who told us that we cannot bill for the assist if the mid-level is not listed in the description of the procedure stating that "Jane Doe assisted with this surgery due to the complexity of the case". Our doc does not typically mention the assistant in the description, but the assist is listed on the surgery report as the assistant.

For a mid-level, is it enough documentation that they are listed on there as the assistant? Or do we really need to have the Doc add that line to all her dictation?

Any help is GREATLY appreciated! Also if you have any reference to support it that would be amazing! I've found conflicting arguments online, which is why I'm posting. Some say you only need that if another Doc is assisting. Others say it's on everything. Just searching for clarification or a majority

Thanks!
Krista

 

[csperoni]

I believe this is only an issue if it is a teaching hospital and there is a residency in the specialty. In that case, you have the backup documentation IF it denies.
If it is not a teaching hosp, or there is no ob/gyn program, a letter from the Chairman of the Dept stating so should suffice in getting you paid if it denies (and no additional info on the op report is needed). I use letters dated from years ago with no problem.

 

[cghanbari]

Hey! I'm new to this wacky world of billing/coding and I have a question regarding our assists on our surgeries. We only have one Doc in the office and she uses our PA or CNM for assists on her surgeries. We have a new coder who told us that we cannot bill for the assist if the mid-level is not listed in the description of the procedure stating that "Jane Doe assisted with this surgery due to the complexity of the case". Our doc does not typically mention the assistant in the description, but the assist is listed on the surgery report as the assistant.

For a mid-level, is it enough documentation that they are listed on there as the assistant? Or do we really need to have the Doc add that line to all her dictation?

Any help is GREATLY appreciated! Also if you have any reference to support it that would be amazing! I've found conflicting arguments online, which is why I'm posting. Some say you only need that if another Doc is assisting. Others say it's on everything. Just searching for clarification or a majority

Thanks!
Krista

I don't think you can bill. At least not in Texas. It has to an MD with an NPI number and tax ID. We use a modifier 80 for assists for suegeries

 

[teresabug]

yes your physician must list the name of the AS in the header and also must document "what" the assistant did. AS is the modifier for PA's. Modifier 80 is to be used for physicians. I.E. if two different physicians do separate procedures on the patient. Like if a general surgeon removes a large breast mass then a plastic surgeon then has to do reconstructive work...Not all procedures "require" the use of an assistant. You can look up the CPT to see if modifier 80 or AS is "allowed".

 

[mitchellde]

yes your physician must list the name of the AS in the header and also must document "what" the assistant did. AS is the modifier for PA's. Modifier 80 is to be used for physicians. I.E. if two different physicians do separate procedures on the patient. Like if a general surgeon removes a large breast mass then a plastic surgeon then has to do reconstructive work...Not all procedures "require" the use of an assistant. You can look up the CPT to see if modifier 80 or AS is "allowed".

I am not sure your example is really what you intended for this scenario. If a physician excises a breast mass and a different physician performs a reconstruction then there is no assistant surgeon. You have two surgeons performing different procedures so each bills their own with no modifier. As far as the AS vs 80, the AS is a Medicare preference. Whether you can use a PA or CNM as an assistant depends first on your individual state licensure. Some states will allow these individuals as assistants and others will not. Then second it will depend on if the surgery performed allows for an assistant. And then last yes the provider must document the presence of the assistant and any part of the procedure that assistant performed or assisted such as the closure.