Understanding Modifier AS: Non-Physician Assistant at Surgery
Introduction
The AS modifier plays a crucial role in accurately reporting non-physician practitioner (NPP) services for assistant-at-surgery. This article provides an in-depth overview of the AS modifier, used to report services rendered by Physician Assistants (PAs), Nurse Practitioners (NPs), or Clinical Nurse Specialists (CNSs) who assist in surgery under Medicare guidelines.
Understanding the AS Modifier
Established by Medicare, the AS modifier identifies services rendered by Physician Assistants (PAs), Nurse Practitioners (NPs), or Clinical Nurse Specialists (CNS) when assisting in surgery as non-team members. This means they are not directly employed by the operating surgeon and provide independent clinical judgment and skills during the procedure.
When to Use the AS Modifier
- NPPs only: This modifier is exclusively for NPPs billing under their own provider number. Medical Doctors (MDs) and Doctors of Osteopathic Medicine (DOs) should not use the AS modifier and utilize modifiers 80, 81, or 82 instead.
- Medicare and Commercial Payers: While the article focuses on Medicare guidelines from 2020, remember that private insurance companies may have different requirements. Always check with each payer to confirm their specific rules regarding the AS modifier.
- Individual Procedure Codes: When multiple procedures are performed in a single surgical session, only the codes eligible for assistant surgeon reimbursement should carry the AS modifier.
- Specific Codes for NPPs: In certain cases, when the surgeon bills a global code (e.g., maternity care), the NPP assisting them might need to bill a specific surgery-only code (e.g., delivery only). However, this exception may not apply to all scenarios, so consulting the relevant guidelines is crucial.
Medicare Reporting Requirements
- Appending the modifier: Attach the AS modifier directly to the procedure code you’re billing.
- Reimbursement: Medicare currently reimburses 85% of the established assistant surgeon rate for NPP services (subject to change; consult latest guidelines).
- Multiple procedures: If billing for multiple procedures within a surgical session, only eligible codes associated with NPP assistance will be reimbursed.
- Surgeon and Assistant Surgeon Codes: In most cases, the NPP assistant surgeon reports the same procedure codes as the primary surgeon. Exceptions may exist for global codes like maternity care, where the NPP might bill the specific surgery code (e.g., delivery only).
Important Considerations
- Not for Physicians: Medical Doctors (MDs) and Doctors of Osteopathic Medicine (DOs) should not use the AS modifier. They have separate modifiers (80, 81, 82) for assistant surgeon services.
- Medicare vs. Private Insurance: While this article focuses on Medicare, private insurance companies may have different rules for using the AS modifier. Always verify specific requirements with each payer.
- Staying Updated: Healthcare regulations and billing codes are subject to change. Regularly consult the latest Medicare guidelines and relevant resources to ensure accurate and compliant billing practices.
If you are unsure and need help with medical billing for your practice, you can always contact us. PrimeCare has an experienced billing and coding team that uses exact modifiers to bring accurate insurance reimbursement. Contact us today to learn more about our medical billing services.
References:
The American Medical Association (AMA) holds the copyright for the Current Procedural Terminology (CPT®) codes and their associated modifiers, including those mentioned in this article (modifiers 80, 81, 82, and AS). The use of these codes and modifiers is governed by the AMA’s Current Procedural Terminology (CPT®) Coding Rules and the Healthcare Common Procedure Coding System (HCPCS) guidelines. This information is intended for educational purposes only and does not constitute legal or medical advice.
