Wiki Modifier AS vs 80

[klopeza]

I bill for a Nurse Practitioner and I use modifier -AS (assistant at surgery services provided by a physician's assistant (PA), nurse practitioner (NP), or clinical nurse specialist (CNS)) when she assists in deliveries but we had an situation where an insurance didn't pay the delivering provider because the charges I billed as an assisting provider were counted as a delivery and not assist, would modifier -80 (Assistant Surgeon) be accepted in this instance? I had an impression that I was not supposed to bill that if the provider is a NP?

 

[Cmama12]

You are correct. AS is the correct modifier to use for an advanced practice provider.

 

[csperoni]

I agree -AS is the correct modifier. I would just add that for deliveries, that is the only situation I am aware of that the assistant may be required to bill a different procedure code than the primary. An assistant at a delivery cannot bill the global maternity codes and must use the delivery only codes. Assuming a vaginal birth, with the delivering physician providing pre and post natal care,
59400 for primary physician global maternity
59409-AS for nurse practitioner assisting at delivery
I will also note some insurances do not like to pay for an assist on delivery without medical necessity.

 

[nielynco]

I agree -AS is the correct modifier. I would just add that for deliveries, that is the only situation I am aware of that the assistant may be required to bill a different procedure code than the primary. An assistant at a delivery cannot bill the global maternity codes and must use the delivery only codes. Assuming a vaginal birth, with the delivering physician providing pre and post natal care,
59400 for primary physician global maternity
59409-AS for nurse practitioner assisting at delivery
I will also note some insurances do not like to pay for an assist on delivery without medical necessity.

And just to add to your answer, payers may also not pay for an assistant at a vaginal birth even when a physician is present except under extraordinary circumstances. Billing as an assistant during a cesarean is normally paid.

 

[AB87]

When it comes to the facility setting does modifier -80 need to be applied?

 

[nielynco]

When it comes to the facility setting does modifier -80 need to be applied?

No. Here is a link to a good article that explains which modifiers are used by physicians and which by facilities: https://careerstep.my.site.com/s/article/CPT-Modifiers-Physician-vs-Facility