If medical practices incorrectly bill for surgical assistants, they risk losing insurance money. A claim is frequently denied because a modifier was utilized incorrectly. Having a firm grasp of billing guidelines helps in minimizing the risk of financial losses.
This post covers every aspect of the surgical assistant billing process, including what a surgical assistant is, how to charge, how to get paid, and how to utilize modifiers effectively.
So, let’s explore everything about billing surgical assistants, from modifier usage to reimbursement.
Surgical Service Assistant
A healthcare provider other than a physician can assist with surgery, including:
- Physician Assistants (PA)
- Clinical Nurse Specialists (CNS)
- Nurse Practitioners (NP)
Surgical service assistants include co-surgeons, team surgeons, and assistant-at-surgery.
An assistant-at-surgery physician provides hands-on assistance to the attending surgeon during an operation.
The operative note should clearly describe what the assisting surgeon did during the procedure for surgical assistants billing.
Billing Surgical Assistants
An assistant surgeon must be board-certified and licensed as a physician in the state where the services are performed. It is one of the prerequisites for billing surgical assistants. The primary surgeon will be compensated at the maximum allowable rate, 100% of the total payment for the primary surgery. If the criteria for assistant surgeon services are met, the assistant surgeon will be entitled to a 16% payment. A surgeon’s assistant may work in an entirely separate medical specialty or the same or a related field.
A physician may utilize modifiers 80 (assistant surgeon), 81 (minimum assistant surgeon), or 82 (when a qualified resident surgeon is not present) when invoicing for surgical assistant services. The modifier AS indicates that a non-physician performed the tasks of an assistant at surgery. When doctors want to disclose surgical help, they must provide the appropriate modifiers required for billing surgical assistants. Non-physician assistants who report surgical services are not permitted to use these modifiers in their documentation.
Modifiers for Surgical Assistants Billing
Below are the modifiers used for billing surgical assistants:
Modifier 80: Adding modifier 80 to the surgical procedure code indicates the services of a surgeon’s surgical assistant. This modifier refers to an assistant surgeon who assists the chief surgeon in every way. It should not be used by providers who are not physicians.
Modifier 81: Adding modifier 81 to the surgical procedure code makes it possible to find minimal surgical aid. This term refers to a surgeon who assists the primary surgeon during surgery but does not perform most of the work. It is more frequently utilized in private insurance billing than in Medicare billing.
Modifier 82: The modifier indicates the unavailability of a qualified resident surgeon during the service, and the service had to be performed in a teaching hospital. The medical record must explain why a resident surgeon was not present.
AS: It is used for billing surgical assistants when a non-physician (PA/CNS/NP) performs the duties of an assistant during surgery.
Co-Surgeon Billing Guidelines
Primary surgeons who are experts in many types of surgery and independently perform distinct components of an operation are compensated at a rate equal to 120% of the maximum payment for the primary procedure.
Here are the things you should know for surgical assistants billing when there are co-surgeons involved:
Applying the rules for multiple procedures is crucial if any operations are performed. In a separate operative report, each surgeon should detail their actions during the operation.
Both co-surgeons must utilize the same procedure code and add modifier 62 to their claims. The entire cost of the procedure will be divided between the three surgeons in an equal manner. Claims submitted by co-surgeons for surgeries identified as eligible for co-surgeons will be denied when both surgeons have the same specialty. When a non-surgical operation is billed with modifier 62 for a co-surgeon, the claim is refused because the co-surgeon concept does not apply.
Team Surgeon Billing Guidelines
Team surgery is an extremely complex treatment involving numerous doctors with various specializations and other highly qualified staff and equipment. No matter how much an operation is permitted to cost, the assistant surgeon is eligible for reimbursement of 16% of that total. If the conditions above are not followed, payment will not be issued for the services. Team surgery excludes unimportant operations, does not entail surgery, or does not require many doctors with diverse specializations, as well as other highly experienced individuals and equipment. Therefore, payers deny the claims for these operations submitted with modifier 66.
Reimbursement Rules for Billing Surgical Assistants
The co-surgeons each receive 120% of the surgery’s maximum payout. Typically, assistant surgeons are compensated at 16% of the highest sum paid for treatment. Each individual is considered when determining who will pay for the team’s surgical procedure. Upon establishing the medical need and appropriateness of assistant surgeon services, reimbursement for services performed by a PA, NP, or nurse midwife may be allowed. They must operate directly under the supervision of a physician to be compensated. The compensation for PA, NP, and nurse midwives is 13.6% of the maximum permissible sum for eligible operations.
This post shed light on important aspects of billing for surgical service assistants. It is important to note that inaccurately billing surgical assistants might result in a loss of insurance payment. So, it is imperative to have a firm grasp of billing guidelines for surgical assistants. An important aspect is the correct usage of modifiers based on the requirements. Modifiers including AS, 80, 81, and 82 are critical for billing surgical assistant services. A wise approach is outsourcing surgical assistant billing to proficient service providers such as Precision Hub (PH).
Precision Hub assists the medical industry with its billing and coding requirements. Our experts are here for you to make billing surgical assistants an easy task.
Email us at firstname.lastname@example.org if you have questions or need assistance with surgical billing.