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modifiers for surgical assistants

  1. #1
    Default modifiers for surgical assistants
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    I work for a a company that bills for RNFA's and CST, and a couple PAs and NP that work as surgical assistants. I know you bill an 81 modifier with the CST and RNFA's and an AS modifier for any PA or NP. The issue I am having is Anthem is stating that they want an AS modifier for PA, NP, RNFA, and CST's. The modifiers in the CPT book and according to Medicare clearly state that an 81 modifier is for a minimal assist, which would be the CST and RNFA, then an AS modifier is only for PA's and NP's. Can Anthem change their description of the AS modifier to include RNFA's for their policies and reimbursement procedures? I'm afraid to bill Anthem with an AS modifier for a provider that does not have the credentials to use the AS modifier. I'm concerned this could be a fraud issue if we use an AS modifier for an RNFA or CST, rather than the 81 modifier for a minimal assist. Any thoughts on this subject? I would appreciate any advice!

  2. #2
    Columbia, MO
    Your definition for modifier 81 is incorrect.
    CPT Modifier -81, minimal assistant at surgery. This includes MD, DO, and DPM provider types and is an assistant surgeon providing minimal assistance to the primary surgeon. This modifier may be used when more than one assistant is involved or if one person assists during a portion of the surgery. This modifier is not intended for use by non-physician assistants (e.g., RN, PA).

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Thanks Mitchell! so when billing for a CST or RNFA which is the correct modifier since the AS modifier is supposed to be for only PAs and NPs?

  4. #4
    Columbia, MO
    It is my understanding that with most payers they are not billable as surgical assistants. Check with the payer.

    Debra A. Mitchell, MSPH, CPC-H

  5. #5
    Yes, I would check with the payer, AS is what I have been told to use for the hospital I work for. Hope this helps!

  6. #6
    Quote Originally Posted by jettagirlfl View Post
    Yes, I would check with the payer, AS is what I have been told to use for the hospital I work for. Hope this helps!
    thanks jettagirl! So do you use the AS modifier for RNFA's and CST as well?

  7. Default assist modifier
    For 13 years I have been billing for my husband who is an CRNFA. For that professional designation, my rule of thumb is to use 80, unless the payor requires AS. I have found that AS is required by United Healthcare, Cigna, Pacificare, Secure Horizons, Golden Rule, Humana, Healthnet, Aetna plans that don't begin with "W" and most Blue Cross plans (except Arizona). Hope this helps.

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