Wiki NP vs AS modifier for assist at surgery

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ahodge90

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Good morning.

I am trying to understand something so any advice would be greatly appreciated. I was taught that when I have an Assist at surgery and it was done by a PA, NP then it would be coded with the AS modifier. I also looked at CMS site for my jurisdiction and found an article published by WPC (our CMS jurisdiction) that says the same, that if I have a surgical assist by a PA/NP then it would be billed with the AS.

I recently was told that that was incorrect and that I should be reporting any assist at surgery from a PA-C and NP with an NP modifier not the AS. Is this correct? And if not, then when would I use that NP modifier??

Here is a snipit of the WPS article that I mentioned earlier.

Assistant at Surgery Modifier Fact Sheet​

PUBLISHED ON FEB 02 2016, LAST UPDATED ON JAN 05 2021
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Jurisdictions: J8A, J5A, J8B, J5B
Definition
An "assistant at surgery" is a physician/non-physician practitioner (NPP) who actively assists the physician performing a surgical procedure. The "assistant at surgery" provides more than just ancillary services.
Facts
  • Global surgery rules do not apply.
  • 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/DO).
  • 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/DO 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 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/DO should not submit the "AS" modifier. This modifier is only valid for use by non-physician practitioners (NPP) when billing under their own provider number.
  • Medicare will deny the service as unprocessable when the MD/DO modifiers (80, 81, or 82) are submitted on the same line of service as the AS modifier.
  • When submitting the AS modifier, the rendering provider is the NPP, not the MD/DO.
  • When the surgeon involves other members of the same group practice in the post-operative care, including an MD/DO or NPP assistant surgeon, the surgeon submits the surgery code with no modifier. This allows Medicare to pay the global fee schedule amount for the surgery procedure code.
  • Fee Schedule for Physicians’ Services – Assistant at Survey. Indicators for services where Medicare allows an assistant at surgery.
    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 pai
 
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What you were told is incorrect - NP is not even a valid modifier and you won’t even find it in the CPT or HCPCS reference materials. It’s possible that a billing system might use that internally for tracking purposes, but if you put it on a claim, I’d imagine it would likely cause a denial.

There are a few payers that ask that NP services be submitted with the SA modifier, but in my experience this is rare. You’re correct that NPs or PAs assisting at surgery should be reported with the AS modifier. It seems that people will tell you all kinds of incorrect things in this business - it’s always a good idea to ask them to back up what they tell you or provide you with a source when you hear something that sounds wrong.
 
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Agree with Thomas. I have found some payers (Work Comp) require an 81 modifier instead of AS for non-MD assistants. In general though, it is AS.
It's very true, you will hear all kinds of crazy advice and ideas from folks (who most times mean well) and if it sounds wrong you should do your own checking. 100% always ask them to back up what they are telling you and not just "because I said so". However, there are times when a specific payer or guideline may differ from CMS.

I also agree there are a lot of different ways practices track things internally and this could be what you were being told.

Edited to add: always be wary when a provider goes to a conference & comes back & says one of their peers is coding something a certain way and it's great (!), so why can't they? (chuckle)
 
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