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PA assistant in surgery

  1. #1
    Default PA assistant in surgery
    Exam Training Packages
    We have billed Medicare for procedure 44140 with an 80 modifier for a PA to assistant in this surgery. Medicare has denied. In contacting them they state there is a different modifier to use with this procedure. Can any give assitance for this modifier?
    Thank you
    Andi M.
    CPC

  2. #2
    Location
    Minneapolis MN
    Posts
    84
    Default
    The -AS modifier is used for assistant at surgery for PAs, NPs,and clinical nurse specialist.

  3. #3
    Location
    Greeley, Colorado
    Posts
    2,045
    Default
    AS is the correct modifier.
    Lisa Bledsoe, CPC, CPMA

  4. #4
    Location
    North Carolina
    Posts
    3,126
    Default
    82 for teaching hospitals

    "Carriers process assistant at surgery claims for services furnished in teaching hospitals on the basis of the following certification by the assistant, or through the use of modifier -82 which indicates that a qualified resident surgeon was not available."

    100.1.7


    otherwise...AS

    "The AS modifier must be on claim for assistant at surgery claims."

    110

    http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf

  5. Default CMS-Payment Indicator-Non Physician Assist at Surgery
    CMS payment guidelines are based on payment indicators per CPT code. For non physician surgical assist at surgery, modifier -AS should be used and the payment indicators are 0, 1, 2 and 9.

    Indicator 0 - payment restrictions for assistants at surgery applies to this procedure unless supporting documentation is submitted to establish medical necessity.
    Indicator 1 - statutory payment restriction for assistants at surgery applies to this procedure, assistant at surgery may not be paid.
    Indicator 2 - payment restrictions for assistant at surgery does NOT apply to this procedure. assistant at surgery may be paid.
    Indicator 9 - No payment will be considered for assist at surgery.

    Know your payment indicators for the CPT codes that you frequently bill, if CMS has deemed medically necessary, payment indicator 2, no further justification is needed to support payment. No additional documentation requirements are needed in your op note.

    Visit CMS payment guidelines website for further info.
    AlisaC

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