We are having an increase in denials for our assistants at surgery. The specific reason being sent back to us is medical necessity. The providers are documenting their assistants name the skill they provided during surgery and how they assisted. I am hoping you might be able to give us a little guidance on what we might be missing either in the Op Note or in our appeal letters.
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Wiki Assistants as Surgery
- Thread starter carmellen12@icloud.com
- Start date
SharonCollachi
Guest
The procedure code itself has to be available for an assistant at surgery. Just because the surgeon says he needs one doesn't mean the insurance will pay it. Are you checking the indicators before the surgery is scheduled (see below from Medicare). Where it says "may not be paid", you can pretty much interpret that as "will NOT be paid".
Assistant at surgery modifier fact sheet
An "assistant at surgery" is a physician who actively assists the physician in charge of a case in performing a surgical procedure. The "assistant at surgery" provides more than just ancillary services.
Facts
Reimbursement equals 16% of the amount otherwise applicable for the global surgery.
Use the "80" modifier when the assistant at surgery service was provided by a medical doctor (MD).
Use the "81" modifier to identify minimum surgical assistant services, and is only submitted with surgery codes.
Use the "82" modifier when the assistant at surgery service was provided by an MD and there was not a qualified resident available. Documentation must include information relating to the unavailability of a qualified resident in this situation.
Use the modifier "AS" for assistant at surgery services provided by a physician's assistant (PA), nurse practitioner (NP), or clinical nurse specialist (CNS). The provider must accept assignment. Medicare allows 85% of the 16% for the assistant at surgery services provided by a PA, NP, or CNS.
An MD/doctor of osteopathic medicine should not submit the "AS" modifier. This modifier is only valid for use by non-physician practitioners when billing under their own provider number.
Note: The operative note should clearly document the assistant surgeon's role during the operative session.
Assistant at surgery indicators
0 = Payment restrictions for assistants at surgery applies to this procedure unless supporting documentation is submitted to establish medical necessity.
1 = Statutory payment restriction for assistants at surgery applies to this procedure. Assistant at surgery may not be paid.
2 = Payment restrictions for assistants at surgery does not apply to this procedure. Assistant at surgery may be paid.
Assistant at surgery modifier fact sheet
An "assistant at surgery" is a physician who actively assists the physician in charge of a case in performing a surgical procedure. The "assistant at surgery" provides more than just ancillary services.
Facts
Reimbursement equals 16% of the amount otherwise applicable for the global surgery.
Use the "80" modifier when the assistant at surgery service was provided by a medical doctor (MD).
Use the "81" modifier to identify minimum surgical assistant services, and is only submitted with surgery codes.
Use the "82" modifier when the assistant at surgery service was provided by an MD and there was not a qualified resident available. Documentation must include information relating to the unavailability of a qualified resident in this situation.
Use the modifier "AS" for assistant at surgery services provided by a physician's assistant (PA), nurse practitioner (NP), or clinical nurse specialist (CNS). The provider must accept assignment. Medicare allows 85% of the 16% for the assistant at surgery services provided by a PA, NP, or CNS.
An MD/doctor of osteopathic medicine should not submit the "AS" modifier. This modifier is only valid for use by non-physician practitioners when billing under their own provider number.
Note: The operative note should clearly document the assistant surgeon's role during the operative session.
Assistant at surgery indicators
0 = Payment restrictions for assistants at surgery applies to this procedure unless supporting documentation is submitted to establish medical necessity.
1 = Statutory payment restriction for assistants at surgery applies to this procedure. Assistant at surgery may not be paid.
2 = Payment restrictions for assistants at surgery does not apply to this procedure. Assistant at surgery may be paid.