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Help on Codin & billling Physician Assistant (PA) Orthopedics

  1. Question Help on Codin & billling Physician Assistant (PA) Orthopedics
    Exam Training Packages
    Hi To everyone,

    I need help on how to code & bill an Physician Assistant (PA) that render a service during a surgery (assist on surgery),what are the things i need to do/ to know to code this claims. I have no Idea on what to do, if anybody knows how to do the process, i really appreciate all the help i can get to understand this stuff.

  2. #2
    North Carolina
    If your surgeon dictates that there was an "assist at surgery" present, the primary surgeon needs to dictate the name of the assist and his/her role. Sometimes a primary surgeon needs an assistant BUT it's not always payable. In order to receive reimbursement for the assistant, the procedure would need to warrant an assistant and, most importantly, be medically necessary. For those services that the assistant was instrumental and medically necessary, you would report the SAME code as the primary surgeon. The modifier would be AS or 80 depending on your carrier (check with your carrier as this will become carrier discretion). To determine if the procedure is payable, you would refer to CMS' fee schedule.

    0= Assistant at surgery may be paid with supporting documentation
    1=Assistant surgery may NOT be paid
    2=Assistant surgery MAY be paid
    9=Concept does not apply

    To find out if the procedure is payable, you would go to...

    At the main "Single HCPC Code " and "Payment Policy Indicatiors"...enter (next)

    Select "next" again"...

    Enter your CPT code in the "HCPC" box
    On your drop down "all mofiers"
    Click "submit"

    The 7th column to the RIGHT will provide a status indicator (0,1,2,9) Refer to above for definition.

    If the procedure is payable and medically necessary, the primary surgeons documentation must list the assistant names and the ROLE of the assistant. CMS is somewhat vague of what is required for assistant surgery documentaion but if your surgeon wants it needs to be documented and why. When you receive denials for the assistant, this information will become critical when submitting an appeal...
    Last edited by RebeccaWoodward*; 11-04-2009 at 06:56 PM.

  3. Smile Physician Assistant (PA)
    Hi Rebecca,
    This is great! Am learning a lot from this, THANK YOU very much for this wonderful piece of information, this will be a big help for me.
    Hope to hear from you in my future queries.
    Again i do appreciate your big help. THANK YOU!!

  4. #4
    North Carolina
    Any time...happy to help~

  5. #5
    Default Assistant Surgeon - Documentation
    Rebecca - you provided great feedback - thank you.

    Do you have a site/source for 'required' documenation for the Assistant Surgeon?

    I have surgeons who are documenting who the Assistant Surgeon is for the procedure, but they are not documenting 'what the role' was during the procedure(s).

    Any help would be appreciated - Thanks!


  6. #6
    North Carolina
    I find that CMS is somewhat vauge on this. Some MAC's are more helpful than others when it comes to providing guidance. When I receive denials for assistant surgery or a request for medical records to support medical necessity, this is what I look for...

    1-Did the primary surgeon indicate the need for the assistant?
    2-Were they present for all or part of the case?
    3-What was the role of the assistant?
    4-Is medical necessity clear?

    Simply supplying the assistant's name & credentials can/most likely result in denials. The AAOS has provided some guidance on this issue...

    Also...there is an article in the January 2008 Coding Edge you may find useful.

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