Wiki Reporting for both surgeon and assistant during surgery, AS modifier

[tatumroe]

I have a provider who now uses an assistant on some of his surgeries and need help coding. From what I have read and understand since the assistant is an ARNP we would report the CPT code for the surgery with an AS modifier. I am unclear however how to report for the surgeon. Is there a special modifier that should be appended to the procedure code to indicate that an assistant was used that would adjust the amount the surgeon is paid since the ANRP will also be reporting as well? Does Medicare allow for the AS modifier or would we will globally with no modifiers only under the surgeon? I also understand that the assistant has to have "hands on" during the surgery not just handing the surgeon tools. The current patient I am billing for is self pay so I am also not sure how to adjust the cash discounts to report for the surgeon's portion and then for the assistant's portion. Any help and guidance on how to correctly report for this and how the payers process would be appreciated.

 

[csperoni]

The primary surgeon's bill is not changed or altered in any way. For codes that allow an assist, you bill the same CPT as primary surgeon with -AS for NP/PA under the NPP. If you had another physician assisting, then -80 under the additional physician.
The fee schedule for assistant surgeon is usually 16-20% of the primary surgeon's fee schedule. If the assist is NP/PA, that may be further reduced by any NPP reduction.
Medicare for example, pays -80 at 16% and -AS at 85% of the 16% for 13.6% of primary surgeon.
For a self pay patient, I would decide on a set percentage of the primary surgeon and then charge that for all self pay patients.