Neurosurgery Coding Alert

Avoid modifier AS in teaching hospitals

If your surgeon uses a physician assistant (PA) to help out during surgery, you'll want to know the payer you're dealing with before appending either modifier AS or modifier 80 to your claim.

Here are four tips to be sure your PA won't miss out on the reimbursement she deserves. Step 1: Check the Fee Schedule Before billing a PA as a surgical first assistant, you must know if the insurer will reimburse for the PA's services. For Medicare, the easiest way to do this is to consult the Physician Fee Schedule Database.

"Each year, as part of the Physician Fee Schedule, Medicare publishes those procedures for which they approve technical surgical assisting by a physician, physician assistant, nurse practitioner, or clinical nurse specialist," says Ron L. Nelson, PA-C, president and chief executive officer of Health Service Associates Inc., a healthcare consulting firm based in Fremont, Mich.

Look for a 2 in column "U": If the fee schedule lists a "2" in Column U ("ASST SURG"), you can bill for a first surgical assistant.

Likewise, you can report surgical assist if column U contains a "0," but your documentation becomes more important. Typical Medicare policy dictates that when column U lists a 0, reimbursement "for assistants at surgery cannot be paid unless supporting documentation is submitted to establish medical necessity."

A "1" or "9" means no luck: If the fee schedule lists a "1" or a "9" in Column U, you cannot gain payment for a surgical assistant for that procedure.

Tip: The 2005 physician fee schedule database is available as a free download at the CMS Web site www.cms.hhs.gov.

Step 2: Append AS for Medicare Patients The PA serving as a surgery assistant reports the same CPT codes as the primary surgeon. To indicate that a PA provided the services, however, you should append modifier AS (Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery) to claims for Medicare carriers and some third-party payers, says Betty Carpenter, CCS-P, coding and compliance manager for a Grand Rapids, Mich., provider.

Example: The PA serves as surgical first assistant during a diskectomy for a Medicare patient. The primary surgeon claims 63075 (Diskectomy, anterior, with decompression of spinal cord and/or nerve root[s], including osteophytectomy; cervical, single interspace). The PA reports 63075-AS under his own PIN.

Document: The operative report should explain exactly how the PA assisted in the operating room. Also, a form letter, included with the claim and explaining why the surgeon needed the PA's assistance, will help reduce claim delays and denials.

Remember: You should still append modifier 80 (Assistant surgeon) to your Medicare patient's surgical assist claims if a physician performs the assist. Modifier AS [...]