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Modifier 80 and Modifier AS

  1. Question Modifier 80 and Modifier AS
    Exam Training Packages
    We have the following situation:

    Provider outside of our practice performed surgery
    Physician in our practice assisted
    PA in our practice also assisted.

    We billed surgical code with Mod 80 for the physician and surgical code with Mod AS for the PA.

    The insurance only wants to pay for the physician with the Mod 80. I am unable to locate anything that states we cannot bill for BOTH the physician and the PA as assists.

    Does anyone have any information or references regarding this situation? I have not encountered this before.

    Thank you!

  2. #2
    Location
    Baton Rouge
    Posts
    1,239
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    Quote Originally Posted by maddismom View Post
    We have the following situation:

    Provider outside of our practice performed surgery
    Physician in our practice assisted
    PA in our practice also assisted.

    We billed surgical code with Mod 80 for the physician and surgical code with Mod AS for the PA.

    The insurance only wants to pay for the physician with the Mod 80. I am unable to locate anything that states we cannot bill for BOTH the physician and the PA as assists.

    Does anyone have any information or references regarding this situation? I have not encountered this before.

    Thank you!
    Here is one payer's policy stating that they only allow 1 surgical assistant per procedure; this is pretty much in line with others that I've seen. We are often in the same situation, having both an MD and PA assist for other physicians, yet are only able to bill for the MD.
    Hope this helps!

    https://www.oxhp.com/secure/policy/a...rgery_711.html
    Meagan Strauss, CPC, CEMC
    Coding Coordinator
    The NeuroMedical Center
    Baton Rouge, LA

  3. Default
    I can certainly understand why the insurance company does not want to pay for a PA and a surgeon to both assist. Usually a surgery doesnt need more than a surgeon and an assistant so there would be no reason for them to pay for the PA and the surgeon. 2 qualified surgeons should be enought to do a surgery, should not need a PA to assist also.

  4. Default
    Thanks, Meagan! The reference (and your experience with this issue) helps a lot.

  5. Default
    As I did not go to medical school, I don't feel I'm qualified to make the judgement on how many physicians or assistants it would take to perform or assist on a surgery. If you have direct knowledge of the surgery (which I did not name) or something concrete other than the above opinion, please share this nformation.

  6. Default
    There is really no reason to get offended or post a response such as what you did. What I posted was not an opinion. What I posted was billing advice given by attending 15 years of AANS and NASS seminars. Unless it is a very unusual surgery or situation we have been told not to bill for both the PA and a surgeon to routinely assist at surgeries. I will make sure not to answer any posts of yours in the future, I did not intend to offend you, simply to answer your question.

  7. #7
    Location
    Dover Seacoast New Hampshire
    Posts
    1,971
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    Payer rules vary as to how many assistants (if any) they will allow for specific surgical procedures.

    In making an appeal, you'd need to support medical necessity by virtue of the provider's note which should clearly document why two surgical assists were required outside the typical surgical case. Common reasons might be body habitus (morbid obesity), unusual anatomy, or significant extra work due to an unusual condition or situation, excluding surgeon error.

    I also wanted to comment in regards to your post to penguins11; maybe you didn't intend for it to seem so unfriendly. If you don't want to read the responses, perhaps you might not want to post questions. After all, this is a professional discussion board, with very little content monitoring. You can choose to disregard any post you choose, but we all have the right to post our opinions. Hope you understand.
    Pam Brooks, MHA, COC, PCS, CPC, AAPC Fellow
    Coding Manager
    Wentworth-Douglass Hospital
    Dover, NH 03820

    If you can dream it, you can do it. Walt Disney

  8. Default
    Of course I didn't mean to sound unfriendly. And I'm sure penguins11 did not mean to sound patronizing, either. The second response was much more helpful with "Unless it is a very unusual surgery or situation we have been told not to bill for both the PA and a surgeon to routinely assist at surgeries." That type of information is what I was looking for.

  9. #9
    Default
    A follow up question to your question. As of the first of the year we are getting denied on all "AS" physician assisant billing from Noridian Medicare. Is anyone else having this issue? Thank you!

  10. #10
    Location
    Baton Rouge
    Posts
    1,239
    Default
    Quote Originally Posted by lostone65 View Post
    A follow up question to your question. As of the first of the year we are getting denied on all "AS" physician assisant billing from Noridian Medicare. Is anyone else having this issue? Thank you!
    I haven't seen this yet (we have Pinnacle here in LA), but it looks like others with Noridian are having similar issues; see this current thread:

    http://www.aapc.com/memberarea/forum...ad.php?t=67272
    Last edited by mhstrauss; 01-25-2012 at 03:30 PM. Reason: add'l info
    Meagan Strauss, CPC, CEMC
    Coding Coordinator
    The NeuroMedical Center
    Baton Rouge, LA

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