Can a PA bill as an assistant surgeon??

jek521

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In a small ortho practice, the PA acts as an assistant surgeon during procedures. The primary surgeon shares the same tax ID# with the PA.

Are the PA's services separtely billable to Medicare and/or commercial payers? If so, would modifier-80 or -81 be applicable, or perhaps modifier-62?

The only guidance that I've been able to find is CMS CR5221, which indicates that payment for the PA must be made to the employer.

I appreciate any help you can offer!!
Thanks!
Jen
 

JHoots

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PA as SA OK

You can bill insurance (including medicare) for PA's that assist in surgery- even when they have the same tax id. You will, however, need to credential your PA. With Medicare you use the mod "SA" with most other insurances you would use and "81".
 

Lisa Bledsoe

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PA assists at surgery are reported with modifier AS for Medicare and 80 for commercial insurance. Make sure that the procedure codes warrant assists.
Lisa:)
 

Catherine.

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Lewiston, Maine
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As Lisa stated you can bill with an AS or 80 modifier for PA services. The other thing to keep in mind is if the carrier credentials the PA. If they do not then you will have to bill out the PA services under the physicians name with the PA as the rendering provider and the MD as the billing provider with the appropriate modifier as long as the procedure is warranted. I suggest that you check with your commercial carriers to see if they have approved assistant surgeon lists. In my state Anthem and Aetna both have medical policies regarding allowable assistant surgeon codes. A good software program to use is either the AMA's Code Manager or Ingenix's EnCoder Pro which can tell you if a procedure warrants an assistant surgeon.
The 62 modifier is for reporting co-surgeons (two MD's) of different specialties.
 
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documentation

As Lisa stated you can bill with an AS or 80 modifier for PA services. The other thing to keep in mind is if the carrier credentials the PA. If they do not then you will have to bill out the PA services under the physicians name with the PA as the rendering provider and the MD as the billing provider with the appropriate modifier as long as the procedure is warranted. I suggest that you check with your commercial carriers to see if they have approved assistant surgeon lists. In my state Anthem and Aetna both have medical policies regarding allowable assistant surgeon codes. A good software program to use is either the AMA's Code Manager or Ingenix's EnCoder Pro which can tell you if a procedure warrants an assistant surgeon.
The 62 modifier is for reporting co-surgeons (two MD's) of different specialties.

Catherine, do you have a good reference for the required documentation the PA must do to qualify to bill as an assistant?


Thank you!

Laura Crockett
 
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