Ensure Reimbursement for PA In the Surgical Setting
Published on Fri Sep 01, 2000
Physician assistants (PA) often are used as first assistants to the neurosurgeon. Sometimes neurosurgeons do not know the way to ensure proper reimbursement for the PAs services. By using the right modifiers, knowing the individual carriers policies, providing documentation and obtaining preauthorization, you can make sure you are billing correctly and receiving the payment you deserve.
A certified PA is a healthcare professional licensed to practice medicine with physician supervision. When working within a neurosurgeons office, clinic or a hospital setting (wherever they are supervised by a neurosurgeon), PAs in most states may take histories and conduct physical exams, order and interpret tests, handle documentation, assist in surgery and conduct general patient follow-up, among other services.
Michael Powe, PA-C, of the Government and Professional Affairs Department of the American Academy of Physician Assistants in Alexandria, Va., says that the Balanced Budget Act of 1997 expanded the PAs ability to provide care in all settings. But the word has been slow in getting out there with some carriers, says Powe. The neurosurgeon and the PA must understand the PAs scope of practice in his or her particular state and be prepared to advise carriers on this important issue.
Powe gives just one example of the benefits of employing a PA in a neurosurgical setting: If a neurosurgeon uses a PA for services such as postsurgical rounds, which already are paid for under the global surgical package of a procedure, the neurosurgeon can be freed up to go back to the office or see new patients and generate new revenue.
Use the Proper Modifier
James Piotrowski, PA-C, president of the Association of Neurosurgical Physician Assistants, a PA in practice with Neurosurgical Associates of Crystal, Tenn., says that most procedures performed by neurosurgeons require the services of a first assistant. But a second surgeon is not always necessary. A PA often will perform openings and assist with diskectomies (63075, diskectomy, anterior, with decompression of spinal cord and/or nerve root(s), including osteophytectomy), laminectomies (63045, laminectomy, facetectomy and foraminotomy [unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], (e.g., spinal or lateral recess stenosis)], single vertebral segment, cervical), craniectomies (61518, craniectomy for excision of brain tumor, infratentorial or posterior fossa), and more, Piotrowski says. I close everything including skull surgeries and I assist in instrumentation. It is pretty inclusive.
Powe stresses the importance of selecting the proper modifier to identify the services of a PA assisting in surgery. Medicare has eliminated all of its HCPCS modifiers for PAs except the -AS modifier (physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery) for first assisting. Powe says that there are a few non-Medicare carriers that [...]
