ahodge90
Networker
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.
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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
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← Back to the previous page
FB link
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