Neurosurgery Coding Alert

Question: Our office employs an RN who assists our neurosurgeon with surgical procedures. She has just completed her RNFA certification. How should we code for her services? New Mexico 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. In addition, 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 might.

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." Clinical and coding expertise for You Be the Coder and Reader Questions provided by Eric Sandham, CPC, compliance educator for Central California Faculty Medical Group, a group practice and training facility associated with the University of California at San Francisco in Fresno.