Wiki Assistant on Surgery PA: modifier issues

[WynneTegyn]

We have been billed with the AS modifier for assistants on surgery who are PA's. This keeps getting denied. I found something that said that Medicare wants both the AS modifier and the 80 modifier together, but that was an old post, and one of our coders here said that is no longer the case. I'm still having no luck getting these claims paid, though. Does anyone have any insight? Thanks!

 

[bwilliams1]

What insurance are you getting denials from. Medicare does not take the 80 modifier, only the AS.

 

[mhstrauss]

Check with your MAC for guidance--Medicare DOES accept 80/81/82...we've had no problems getting paid using those. I can't find any recent resource from CMS stating that they MUST be used, but I do remember this becoming an issue maybe 2 years ago, when CMS started requiring them...I'll try to find a reference.

 

[tmarugg]

We use the AS modifier and usually the charges get denied on first submission. I appeal with the operative report that indicates the PA was the assistant surgeon. Also, check with your carriers to see if the surgeon and assistant surgeon's charges can be on the same claim. Medicare allows the charges to be on the same claim. But the PA's NPI and MCR provider number must be in box 24j. Some carriers require that they be billed separate.

Hope this helps.

 

[hopepg]

It might depend on what payers allow you to bill the PA direct.

For instance, when we had a PA start in our clinic early this year. We had to contact each of our contracted insurance companies to find out if they will allow us to bill under the PA name/NPI direct. If they said they allowed it, we would then confirm with them if the PA needs to be credentialed or what was required at that point. Some plans just had us add the PA information to our existing contract. It just depends payer to payer.

After you have determined what payers require for the PA - bill out the surgery CPT codes with the AS modifier appended to each code. The AS is specific to a NPP type of provider - which is what a PA falls under.

The payers that don't allow us to bill under the PA name/NPI - we bill those charges under the primary surgeon (separate from the primary surgeon claim) & list the PA as the servicing provider & append AS to each line.

You will also want to keep an eye on the CPT codes that allow for assistant surgeons. This information can be found at:

https://www.cms.gov/apps/physician-fee-schedule/license-agreement.aspx

 

[WynneTegyn]

What insurance are you getting denials from. Medicare does not take the 80 modifier, only the AS.

Medicare, and payors that follow Medicare. Can we use 80 if the provider is a PA? Isn't that just for MD or DO? Thanks!!

 

[mhstrauss]

Medicare, and payors that follow Medicare. Can we use 80 if the provider is a PA? Isn't that just for MD or DO? Thanks!!

We've used 80 and 82 for PA's and NP's with no problems from Medicare. Our commercial payers don't require these, just the AS.