Last week, we opened Pandora’s box on co-surgeons and team surgery. Notably left in the box was a discussion on assistant(s) at surgery. Typically this arises when physicians or non-physician practitioners assist during a procedure, but don’t perform any surgery.
To qualify for reimbursement, the California regulations are more ambiguous and require more documentation than required for co-surgeons and team surgery.
Assistant at Surgery: What Is It?
Under some circumstances, when a procedure doesn’t require the skill of a second surgeon, but either the patient’s condition or surgical complexity requires an assistant, the services of the assistant at surgery are reimbursable. A physician (MD) assistant surgeon is paid 16% of the reimbursement for the applicable surgical CPT code. For non-physicians (e.g. physician assistants, nurse practitioners, or clinical nurse specialists), acting as an assistant at surgery, this amount is further reduced to 13.6% of the surgical reimbursement.
The following is a summary of the role assistant at surgery plays and what qualifies:
Assistant at surgery - Though not explicitly defined in 8 CCR §9789.16.8, an assistant at surgery is a physician or non-physician practitioner who actively assists the surgeon and goes beyond providing ancillary services.
- Physician assistant at surgery:
- Service performed by a medical doctor (MD) use modifier -80
- Minimal surgical assistant services by a medical doctor (MD) use modifier -81
- Performed by an MD when no qualified resident available use modifier -82
- Non-Physician assistant at surgery:
- Service performed by a physician assistant, nurse practitioner, or clinical nurse specialist use modifier -AS
- Physician (modifiers -80, -81, or -82) reimbursement is 16% of the global surgery fee schedule amount per 8 CCR §9789.16.8.
- Non-Physician Practitioner (modifier -AS) reimbursement is 13.6% of the surgical reimbursement rate, per 8 CCR §9789.15.1
When is an Assistant at Surgery Warranted?
Not all surgeries qualify for an assistant at surgery. To determine whether a surgical CPT code qualifies for an assistant requires you to reference the Medicare Physician Fee Schedule RVU information for the specific surgical CPT code.
The Medicare Physician Fee Schedule RVU table is a dense and expansive spreadsheet bursting with data that many will find difficult to navigate. To download the current RVU file for dates of service in 2019 go to the CMS website, then:
- Download RVU19A.zip;
- Open PPRRVU19_V1213.xlsx (or .csv or .txt);
- Find the relevant CPT.
- There is a column in the spreadsheet entitled:
- “Asst Surg,” or Assistant at Surgery (column U)
- Per 8 CCR §9789.16.8, the column indicators are assigned the following reimbursement designations:
- “0” indicates “the physician or non-physician practitioner must submit documentation to establish medical necessity for use of an assistant at surgery”.
- “1” indicates “assistant at surgery is not payable”.
- “2” indicates the assistant at surgery may be paid (our emphasis).
Required Documentation for Assistant at Surgery Reimbursement
According to 8 CCR §9789.15.1 in order for a non-physician practitioner (NPP) to be eligible for reimbursement, the NPP must “actively assist a physician in performing a surgical procedure.” Further, this regulation requires that the NPP must furnish “more than just ancillary services.”
Getting reimbursed for an assistant at surgery requires two critical components:
- Knowing the Assistant at Surgery indicator assigned by in the Medicare RVU table, and
- Documenting that the assistant actively assisted the physician, beyond ancillary services.
But Wait… There’s an Easier Way
Finding whether a procedure allows for an assistant at surgery is straightforward with DaisyBill’s easy-to-understand software. Subscribe to DaisyBill’s Wizard and use the OMFS Calculator to look up surgical CPT codes to determine whether the code allows for a surgical assistant. For each procedure code, the OMFS Calculator displays the “Assistant at Surgery” column with the assigned indicators. No need to go through CMS’ massive spreadsheet -- we support multiple billing codes and modifiers too.
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