Wiki Assistant Surgeon Billing for NPs

[jharader]

Is appending the -AS and -80 modifier still valid??

""Remember to Append Modifier AS for Specific Cases

Medicare will only pay for a surgical assistant when the procedure performed is authorized for an assistant, and the person performing the service is a physician, physician assistant (PA), nurse practitioner (NP), or a clinical nurse specialist (CNS).

When a PA, NP, or a CNS assists at surgery, you should append modifier AS (Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery) to the surgical code along with modifier 80.

Without modifier AS, modifiers 80, 81, and 82 indicate that a physician was the surgical assistant. So, claims you submit that include modifier AS without modifier 80, 81, or 82 will be returned to you.""

This was in a 2021 AAPC article.

 

[thomas7331]

Is appending the -AS and -80 modifier still valid??

""Remember to Append Modifier AS for Specific Cases

Medicare will only pay for a surgical assistant when the procedure performed is authorized for an assistant, and the person performing the service is a physician, physician assistant (PA), nurse practitioner (NP), or a clinical nurse specialist (CNS).

When a PA, NP, or a CNS assists at surgery, you should append modifier AS (Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery) to the surgical code along with modifier 80.

Without modifier AS, modifiers 80, 81, and 82 indicate that a physician was the surgical assistant. So, claims you submit that include modifier AS without modifier 80, 81, or 82 will be returned to you.""

This was in a 2021 AAPC article.

I believe this must be an error in the AAPC article. I've only ever coded, or seen coded, non-physician assistant-at-surgery claims with just the AS modifier, not with both modifiers. I've never worked with a practice that used both modifiers AS and 80 together on the same claim, and never have come across a payer policy that required both modifiers. I have no idea from what source that AAPC article took this guidance. I think this information must be very out of date.

 

[csperoni]

100% agree with @thomas7331. I've been coding for ACPs at surgery since 2004 and never, ever, ever (even once) put -AS AND -80 on the claim.
Way back in the day, there were some carriers not credentialing PAs who always wanted the claims billed incident-to the physician (including surgical assists) and had specific instructions to do so with -80. But any claim billed under the PA or NP had -AS. If you could provide what 2021 article that was in, perhaps it could be corrected.

 

[amyjph]

Is this where you saw it? https://www.aapc.com/codes/coding-n...odifiers-with-this-handy-guide-166827-article
This part of the article is not correct.

I agree as above, never append both modifiers.

CMS IOM https://www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/clm104c12.pdf
20.4.3 - Assistant-at Surgery-Services (Rev. 2656, Issuance: 02-07-13, Effective: 02-19-13, Implementation: 02-19-13) For assistant-at-surgery services performed by physicians, the fee schedule amount equals 16 percent of the amount otherwise applicable for the surgical payment. A/B MACs (B) may not pay assistants-at-surgery for surgical procedures in which a physicianis used as an assistant-at-surgery in fewer than five percent of the cases for that procedure nationally. This is determined through manual reviews. Procedures billed with the assistant-at-surgery physician modifiers -80, -81, -82, or the AS modifier for physician assistants, nurse practitioners and clinical nurse specialists, are subject to the assistant-at-surgery policy.

110.2 - Limitations for Assistant-at-Surgery Services Furnished by Physician Assistants The AS modifier must be reported on the claim form when billing PA assistant-at-surgery services.

120.1 - Limitations for Assistant-at-Surgery Services Furnished byNurse Practitioners and Clinical Nurse Specialists Only the AS modifier must be reported on the claim form when a NP or CNS bills assistant-at-surgery services.