Assistant surgeon

July 19th, 2009 - Codapedia Editor
Categories:   Coding   Medicare   Medicare Physician Fee Schedule (MPFSDB)   Surgical Billing & Coding  
0 Votes - Sign in to vote or comment.

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.

###

Questions, comments?

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.


Latest articles:  (any category)

​​Polysomnography Services Under OIG Scrutiny
September 2nd, 2021 - Raquel Shumway
The OIG conducted a study dated June 2019 wherein they indicated that there were approximately $269 million in overpayments for polysomnography services for the period of 2014 through 2015. According to the OIG “These errors occurred because the CMS oversight of polysomnography services was insufficient to ensure that providers complied with Medicare requirements and to prevent payment of claims that didn’t meet those requirements.” So what are those requirements?
Medicare Advantage - The Fastest Growing Government-Funded Program Undergoing Multiple Fraud Investigations
August 16th, 2021 - Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content
Medicare Advantage is the fastest growing form of government-funded healthcare and the rate of fraud within this segment has come under increased scrutiny. Funding is determined by the health status of each beneficiary; therefore, accurate coding based on detailed documentation makes the medical record vital to the process because some ...
Billing Dental Implants under Medical Coverage
August 12th, 2021 - Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
Implants can be costly to the patient and the provider, and it is crucial to understand how to bill a patient’s medical insurance to ensure there is adequate coverage for the best treatment. Implants are commonly billed in a dental office under a patient’s medical benefits.    Implants could be considered ...
New Codes for COVID Booster Vaccine & Monoclonal Antibody Products
August 10th, 2021 - Wyn Staheli, Director of Research
New codes have been announced for the COVID-19 booster vaccine, Novavax vaccine, and monoclonal antibody treatment.
Medicare's ABN Booklet Revised
July 29th, 2021 - Wyn Staheli, Director of Research
The “Medicare Advance Written Notices of Non-coverage” booklet, published by CMS’s Medicare Learning Network, was updated. This article discusses the changes to this booklet regarding the use of the ABN.
Chronic Pain Coding Today & in the Future
July 19th, 2021 - Wyn Staheli, Director of Research
Properly documenting and coding chronic pain can be challenging. As is commonly the case with many conditions, over the years, there has been a shift in the identification of different types of pain, including chronic pain. Understanding where we are now and where we are going will help your organization prepare for the future by changing documentation patterns now.
How Does Global and Professional Direct Contracting (GPDC) Affect Risk Adjustment?
July 15th, 2021 - Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content
CMS recently announced the 53 Direct Contracting Entities (DCEs) that will be participating in the April 1, 2021 through December 31, 2021 Global and Professional Direct Contracting (GPDC) Model. Among those participating is Clover Health Partners, who runs an in-home primary care program that has the potential to help Medicare ...



Home About Contact Terms Privacy

innoviHealth® - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain)

Copyright © 2000-2021 innoviHealth Systems®, Inc. - CPT® copyright American Medical Association