Wiki Modifier AS vs 80

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Lisa Bledsoe

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There is a debate in my office as to whether or not PA's and NP's should use AS or 80. My co-worker is under the impression that AS is only for Medicare...which I disagree. I was taught and still believe that AS is for a non-physician assistant at surgery. If I am wrong, please let me know. If I am correct, does anyone have anything "in writing" that I can present to my co-worker? Thanks all!
 
My area of the world requires AS for non-practioners. The only exception is Medicaid...they do require 80. Below are a couple of our main carriers.

Medcost=Adjustment for Charges Made by an Assistant Surgeon:
Charges by credentialed MD assistant surgeons will be limited to 20% of the
MedCost allowable amount unless your contract states otherwise. Credentialed non-MDs will be limited to 14% of the MedCost allowable amount unless your contract states otherwise. Charges for assistant surgeons are not allowed unless the presence of an assistant surgeon is necessary due to the complexity of the procedure or the condition of the patient. To assure accurate repricing, MedCost requests that all providers file assistant surgeon charges with the full surgeon rate, applying the 80, 81, 82, or AS modifiers. MedCost will determine the allowable expense based on the policy and procedures in place for the modifier and provider of service billed. Please note: MedCost only reprices the claim. The claim administrator makes payment consideration for assistant surgeon charges based on the plan design.


UHC=Assistant surgeons who are not physicians should submit the identical procedure code(s) as the primary surgeon with the following modifier to represent their service(s):

Modifier HCPCS Level II Description
AS Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery

BCBS NC=Billing/Coding/Physician Documentation Information
This policy may apply to the following codes. Inclusion of a code in this section does not guarantee that it
will be reimbursed. For further information on reimbursement guidelines, please see Administrative Policies
on the Blue Cross Blue Shield of North Carolina web site at www.bcbsnc.com. They are listed in the Category
Search on the Medical Policy search page.
Applicable Codes:
Co-Surgeon modifiers are -62 or -66.
Assistant surgeon modifiers are -80,-81, or -82.
Physician assistant modifier is -AS.
 
I am not aware of it being Medicare only. We use it for all our carriers when we have a PA assisting in surgery. With Medicare you are supposed to use both the AS and the appropriate 80, 81, or 82 modifier together.

http://www.cms.hhs.gov/ContractorLearningResources/downloads/JA6123.pdf

That is a medicare link but the definition of the AS and 80 modifiers in HCPCS and CPT seem clear enough. The 80 by itself indicates another MD or DO assisted, when you add the AS that clarifies that it was a PA, NP, or CNS.

That is my understanding, but if someone has information to the contrary I would be interested in seeing it.

Thanks

Laura, CPC
 
Are you quoting a denial or guideline from your MAC?

Per Palmetto GBA:

HCPCS Modifier AS

Assistant Surgeon (non-physician)
•Physician assistant, nurse practitioner or clinical nurse specialist services who participated as an assistant to a surgeon

CPT Modifier 80
Assistant Surgeon (Physician)
•Surgeon who participated as an assistant to a surgeon

CPT Modifier 81
Minimum Assistant Surgeon
•Surgeon who participated as an assistant to a surgeon

http://www.palmettogba.com/palmetto... Specialty~Surgery~8EEL8H3275?open&navmenu=||
 
PA as assistant at surgery; List of CPT codes for AS mod

I"m reading that info from Palmetto as 80 & 81 say "Surgeon". If our assistant is a PA then I would only use modifier AS. Our PA is not a surgeon.

Am I correct in this thinking?

Also, does anyone know of a link to specific procedures that the PA can assist with? I've done search after search and can't seem to locate one.

Thanks!
 
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