Whether or not an assistant surgeon is allowed is determined by the Medicare Physician Fee Schedule Data Base. All surgical procedures have an indicator in the Medicare Fee Schedule that tells whether or not an assistant surgeon is allowed. There are four indicators.
Zero = Payment restriction for assistant at surgery applies to this procedure unless supporting documentation is submitted to establish medical necessity.
One = Statutory payment restriction for assistants at surgery applies to this procedure. Assistant at surgery may not be paid.
Two = Payment restriction for assistants at surgery does not apply to this procedure. Assistant at surgery may be paid.
Nine = Concept does not apply.
When looking in the Medicare Fee Schedule, services with a two indicator are allowed to be paid an assistant surgeon.
There are four modifiers to use for an assistant surgeon.
Modifier 80 is for an assistant surgeon.
Modifier 81 a minimum assistant surgeon.
Modifier 82 an assistant surgeon when qualified resident surgeon is not available. This modifier is used in teaching facilities to indicate that a resident who normally would be providing the assistant surgeon services was not available.
AS is an HCPCS modifier to indicate that a physician assistant, nurse practitioner, or clinical nurse specialist services were used for an assistant surgeon when the patient has Medicare.
It is not permissible for a practice to bill the patient for assistant surgeon services when that service is not allowed by Medicare. Practices should check the Medicare Physician Fee Schedule Database to see if an assistant at surgeon is allowed. When a Non-Physician Practitioner (NPP) provides this service on a Medicare patient, use modifier AS.
If you have questions or comments about this article please contact us. Comments that provide additional related information may be added here by our Editors.
Codapedia friends, come and join us at Find-A-Code - a core product of innoviHealth! The information found on Codapedia comes from our sister company, Find-A-Code. If you do not already have a subscription with the greatest online coding encyclopedia, call us and get signed up today. We are offering a ...
A new OIG report once again highlights the necessity for organizations to fully understand requirements for reporting services and having proper documentation. The types of problems addressed in this report are ongoing issues for multiple types of services and specialties and for many different payers.
We attended the recent virtual RISE National Conference and had the opportunity to listen to presenters share their knowledge about risk adjustment and HCC reporting and data validation. Among the presenters were representatives from the Office of Inspector General (OIG), who presented findings from encounter data from 2012-2016. They began ...
The initial treatment in rehabilitation for patients suffering from Intermittent Claudication (IC) is Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD). Rehabilitation using SET involves the use of intermittent walking exercise, which alternates periods of walking to moderate-to-maximum claudication, with rest.
When reporting 93668 for peripheral arterial disease rehabilitation the following ...
Hello HCC Customers!
We have made a change in name only to our HCC subscription. The new subscription is now called “HCC Plus”. Keep in mind there have been no changes to the product.
Using your subscription along with the risk adjustment calculator will ensure you stay current with...
The National Correct Coding Initiative (NCCI) edits were developed by CMS to help promote proper coding and control improper coding that leads to incorrect payments with part B claims. It is important to understand that NCCI edits do not include every possible code combination or every type of un-bundling combination. With that ...
Surgical and medical services often include work that is required to be done prior to a procedure and post-procedure. When there are multiple procedures done by the same physician, group, or another qualified healthcare professional on the same day, the pre and post work is only required once. Therefore, CMS ...