General Surgery Coding Alert
Billing for RNFA Surgical Assist
Question: Our office employs a RN who assists our surgeon with surgical procedures. She has just completed her RNFA certification. How should we report her services? Arizona Subscriber Answer: The answer depends on the insurer, but in most cases you cannot bill. A registered nurse/first assistant (RNFA) is a registered nurse (RN) who has undergone additional training, available through the National Surgical Assistant Association, to serve as a surgical first assistant. Medicare and most public aid programs will not pay for an RNFA. And an RNFA is not licensed to practice medicine and may not perform any services independent of the physician as a nurse practitioner or physician's assistant may.
Private payers who reimburse RNFA services may require that modifier -81 (Minimum assistant surgeon) be appended to the appropriate procedure code(s), although some will allow higher payment with modifier -80 (Assistant surgeon). Other private payers may accept HCPCS modifier -AS (Physician assistant, nurse practitioner or clinical nurse specialist services for assistant at surgery).
Because RNFAs have no universal provider identification number (UPIN), you will have to ask the individual insurer how to identify them on the claim form. Usually, the RNFA will use the physician's UPIN (which can make it appear as if the physician assisted him- or herself) or a "generic" UPIN, such as "RNFA01."
General Surgery Coding Alert
- Part 1:
Step-by-Step Approach Simplifies Even Complex Wound Repairs
Several variables govern coding for wound repair and, especially for wounds of different severity and [...] - Medicare Treats Tissue Adhesives Differently
CPT treats tissue adhesives identically to stitches or staples, allowing 12001-13160 to report wound closure/repairs [...] - Documentation Is Crucial for Wound Repair
Because of the many variables involved in choosing wound repair/closure codes, and because payers can [...] - CCI 101:
Understanding the Edits
The national Correct Coding Initiative (CCI), first issued in January 1996 and updated each quarter [...] - You Be the Coder:
Aspiration During Global Period
Test your coding knowledge. Determine how you would code this situation before looking at the [...] - Massive CCI 8.3 Injects New Edits Into Surgical Practice
CMS, along with the National Technical Information Service (NTIS), has released version 8.3 of the [...] - READER QUESTION:
After-Hours Codes With On-Call Status
Question: Is it appropriate to report the after-hours codes if the physician sees the patient [...] - READER QUESTION:
Billing for RNFA Surgical Assist
Question: Our office employs a RN who assists our surgeon with surgical procedures. She has [...] - READER QUESTION:
Laparoscopic Fundoplications
Question: I recently encountered two different situations with laparoscopic fundoplications: In the first case, the [...]
