TnRushFan
Guru
Good morning all,
I work in a teaching hospital (we cannot use-80). On occasion when there is no qualified resident or there are exceptional patient circumstances our surgeons request assistant surgeons (or PA's) to participate in their surgery. Some of our surgeons have requested 'sample documentation' of what they would need to document in the op note. We've told them they need to not only say the assistant surgeon or PA was in the O.R. but they were actively participating in the surgery, what exactly they were doing and why the extra qualified provider was necessary in the first place.
Does anyone have any 'example documentation' that I can share with my Surgeons for when an assistant surgeon or PA assists during a surgery?
Any input is greatly appreciated!
We have already shared the following:
I work in a teaching hospital (we cannot use-80). On occasion when there is no qualified resident or there are exceptional patient circumstances our surgeons request assistant surgeons (or PA's) to participate in their surgery. Some of our surgeons have requested 'sample documentation' of what they would need to document in the op note. We've told them they need to not only say the assistant surgeon or PA was in the O.R. but they were actively participating in the surgery, what exactly they were doing and why the extra qualified provider was necessary in the first place.
Does anyone have any 'example documentation' that I can share with my Surgeons for when an assistant surgeon or PA assists during a surgery?
Any input is greatly appreciated!
We have already shared the following:
| Modifier 80 Assistant Surgeon Modifier 80 identifies surgical assistant services and is applied to the surgical procedure code(s). Assisting physicians usually charge 20 to 25 percent of their normal fee for performing the surgery alone. Payers often use the surgeon’s contract rate to figure the assistant’s percentage, and do not pay a resident an assistant surgeon fee. Although this modifier is preferred by most payers to report an assistant surgeon, always monitor the explanation of benefits (EOBs) and maintain a list of carrier preferences. Medicare and Modifier 80 [as a teaching hospital we cannot use -80 modifier] Medicare restricts the use of modifier 80 to the primary procedure performed. Where payment for an assistant surgeon is allowed, payment is based on 16 percent of the fee schedule payment amount. Modifier 81 Minimum Assistant at Surgery Minimum surgical assistant services are identified by appending modifier 81 to the usual procedure code. Modifier 82 Assistant Surgeon Modifier 82 indicates that the procedure was performed requiring the presence of an assistant surgeon when a qualified resident surgeon was not available. In teaching hospitals, special requirements must be met to allow billing for an assistant surgeon, and modifier 82 is typically used in those instances. Check with your Medicare carrier for details. Box 19 on the CMS-1500 form can be used to type a message to indicate that a qualified resident surgeon was not available. Modifier AS-Assistant at Surgery Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery are identified by adding the HCPCS Level II modifier AS to the usual procedure code. This modifier may only be submitted with surgery codes, and additional documentation is required upon submission. Documentation required in the medical record: 1. A statement that no qualified resident was available to perform the service, or 2. A statement indicating that exceptional medical circumstances exist, or 3. A statement indicating the primary surgeon has an across-the-board policy of never involving residents in the preoperative, operative, or postoperative care of his/her patients. Be Aware of Limitations CMS’ Guidelines 20.4.3—Assistant at Surgery Services (Rev. 1, 10-01-03) B3-15044 state: For assistant at surgery services performed by physicians, the fee schedule amount equals 16 percent of the amount otherwise applicable for the global surgery. Carriers may not pay assistants at surgery for surgical procedures in which a physician is used as an assistant at surgery in fewer than five percent of the cases for that procedure nationally. This is determined through manual reviews. In addition to the assistant at surgery modifiers 80, 81, or 82, any procedures submitted with modifier AS are subject to the assistant surgeon’s policy enunciated in the Medicare Physician Fee Schedule (MPFS) database. They will pay claims for procedures with these modifiers only if the services of an assistant surgeon are authorized. Physicians are prohibited from billing a Medicare beneficiary for assistant at surgery services for procedure codes subject to the assistant at surgery limit, and are not permitted to circumvent this by using an advance beneficiary notice (ABN). Physicians who knowingly and willfully violate this prohibition and bill a beneficiary for an assistant at surgery service for these procedure codes may be subject to the penalties contained under §1842(j)(2) of the Social Security Act. Penalties vary based on the frequency and seriousness of the violation. To determine whether the services of an assistant surgeon may be submitted to Medicare with modifier AS, refer to the Medicare Physician Fee Schedule database. Refer to the column heading “Asst Surg.” MPFS Payment Indicators Indicator 0—Payment restriction for assistants at surgery applies to this procedure. Supporting documentation (as described earlier) may be submitted on appeal. Indicator 1—Statutory payment restriction for assistants at surgery applies to this procedure. Assistants at surgery will not be paid. Indicator 2—Payment restriction for assistants at surgery does not apply to this procedure. Assistants at surgery may be paid. Indicator 9—Concept does not apply (the most likely explanation is that the procedure is not a surgery). |
| To successfully bill for a Physician Assistant (PA) assisting during surgery, the operative report must clearly document the PA's specific role and activities, including why an assistant was needed and why a resident wasn't available. Here's a breakdown of the required documentation: 1. Operative Report Requirements: Explicit Documentation of the PA's Role: The operative report should clearly state that a PA assisted during the surgery and detail the specific activities the PA performed, not just listing their name. Justification for the Assistant: The surgeon should explain why an assistant was needed for the procedure, including the complexity of the case or the need for additional help. Medical Necessity: The operative report must demonstrate the medical necessity for the assistant-at-surgery, and the primary surgeon must substantiate that. Resident Availability: If a resident was not used, the operative report must explain why a qualified resident was not available, such as scheduling conflicts, emergency cases, or exceptional clinical circumstances. Name and Credentials: The operative report should include the name and credentials of the assisting PA. Specific Activities: The documentation should clearly state what the PA did during the surgery, such as suturing, retracting tissue, or assisting with specific surgical steps. |