Modifier AS

Modifier AS (2022) Description, Uses, Guidelines & Examples

Modifier AS applies when the Physician assistant, clinical nurse specialist, or nurse practitioner performs service as an assistant at the surgery. 

Modifier AS Description

Modifier AS applies when the Physician assistant, clinical nurse specialist, or nurse practitioner performs service as an assistant at the surgery. Non-physician providers (NPPs) play a significant role in numerous practices, such as Orthopedics which raises the issue of how to code and bill for the service when working as an assistant or assisting the principal physician. CMS Medicare and commercial have guidelines on when to bill for modifiers for assistants. 

Medicare allows to bill the non-physician assistant services with modifier AS. They have special instructions regarding modifier AS when NPP assists a surgeon that NPP name bills for their service under the provider number (National Provider Identifier or NPI) along with modifier AS.

Modifier AS, when appends with the service according to the national Medicare policy and do not pertain to the local reimbursement policy.Modifier AS bills the services of NPP as an assistant when submitting the medicare insurance. It will lead to denials with modifier 80.

Medicare provides equal billing rights to clinical nurse specialists such as NPPs, physician assistants (PAs), and nurse practitioners. It includes certified surgical tech, registered nurse first assistant, and orthopedic physician assistant (OPA or ortho tech). 

Medicare may not recognize some other skilled clinicians for reimbursement. It requires additional graduate studies and undergraduate, association certification, and state licensure. 

The OPA looks similar to a physician assistant but is entirely different. They may not meet the requirements for PA. Billing modifier AS with these other clinicians’ claims is inappropriate when submitted to Medicare.

Unlike Medicare, Commercial insurance may accept the claims of these other clinicians and make them eligible for reimbursements as an assistant in surgery varies on beneficiary plans or reimbursement policy guidelines. If they allow for the price, it is appropriate to report with required modifiers in an acceptable format according to the written directives such as AS. The state laws may also influence the payment of the clinicians. 

The following is the list of modifiers to report the service of an assistant surgeon:

Modifier AS applies when the Non-physician provider (NPPs) provides the service as an assistant at surgery.

Modifier 80 instead of AS applies when the physician provides the service as an assistant at surgery. It indicates that an assistant surgeon aids the primary surgeon.

Modifier 81 instead of AS applies when the physician provides the minimal service as an assistant at surgery. It indicates that an assistant surgeon aids the primary surgeon and omits NPPS. This modifier usually appends with commercial insurances, and Medicare does not accept this for NPPS.

Modifier 82 instead of AS applies when a qualified resident surgeon is unavailable in a teaching facility. It is only applicable when service renders in the teaching facility, and skilled resident surgeons are unavailable. Otherwise, insurance may deny this claim with this modifier 82.

The circumstance should support the reasoning that a resident surgeon is unavailable and may cause the patient’s death. This modifier may not be intended for use by non-physician providers.

Modifier AS does not applies to evaluation and management codes 99202-99499, and It is appropriate to report with E/M modifiers such as 25, 24, 57, etc. 

Modifier AS frequently bills with the surgical procedure when NPPs provide services as an assistant at the surgery. 

Modifier AS is not applicable with Radiologiccals services, pathology and laboratory services, and Medicine sections CPT codes. It is an appropriate report with relevant modifiers.

as modifier

What Is Modifier AS?

Physician appends modifier AS when bills to the insurance on behalf of the APN, CRNA, or PA. It is only applicable when serving as an assistant for the procedure or surgery.

When To Use Modifier AS

Modifier AS appends for the service when the Non-Physician practitioners (NPPs) assist the primary surgeon in the surgery.

The NPPS requires actively assisting the principal surgeon in surgery and contributing to the overall procedure. Documentation should support the service of an assistant renders during the service, such as an operative report.

Modifier AS is not applicable with service performed as an assistant other than the NPPs or

Modifier AS may not use if the Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist acts as a substitute and not a surgical assistant in place of another surgeon.

Modifier AS Guidelines

The following are guidelines when modifier AS appends with CPT codes:

Modifier AS indicates the service provided by the Physician assistant or NP as a surgical assistant. 

Modifier AS is not applicable on the same claim with modifier 81, 80, or 82 on the same day by the same provider.

Documentation should support the medical necessity of service and be medically appropriate. It should submit with the assistant surgeon indicator “0” on the claim. It indicates payment restrictions for assistants at the surgery unless the documentation supports the medical necessity of service.

Documentation must be offered during claim submission and represents the assistant surgeon’s role during the operative session. 

Modifier AS does not apply to evaluation and management procedures (99201-99499). It is only applicable to surgical procedure code range 10000 to 60000. It is appropriate to report with E/M Modifiers 25, 24, 57, etc.

If claims submit with a “1” indicator along with the modifier AS the Statutory payment restriction applies to this procedure for assistants at surgery and may not pay by the insurance. 

If claims submit with indicator “2” along with the modifier AS, the Statutory payment restriction doesn’t apply to this procedure and may pay by the insurance. 

If the service reimburses in a teaching facility or hospital, the following documentation needs before insurance billing:

Documentation requires that a qualified resident is unavailable when service renders to the patient.

The service renders to the patient in exceptional medical circumstances. Otherwise, It may lead to the death of the patient.

The statement requires when the physician may have an across-the-board policy of never involving residents in their patients’ preoperative, operative, or postoperative care.  

Physicians who submit the claims with modifiers 80, 81, and 82 will reimburse 16 percent of the money otherwise applicable for the surgical payment account to the PFS schedule. In contrast, PA, CNS, or NP submit the claim to Medicare with modifier AS will be paid 85% of the 16% for the assistant at surgery services.

Modifier AS Examples

The following are the examples of when modifier AS appends with the CPT codes:

Example 1

A 39-year-old male with tumors on the lumbar region presented to the emergency department with c/o constant low back pain that started four days ago. The patient was unable to walk for 1-week. 

The patient is consulted with his primary care physician and suggested to go emergency department. Denies trauma, heavy palpitations, dizziness, cough, recent illness, fever, chills, back pain, abdominal pain, nausea, recent travel, known sick contacts, current antibiotic use, near-syncope or syncope, changes in stool color, urinary complaints, or any other symptoms. 

The patient took his routine medication. The physician ordered a CT scan of the lumbar region and laboratory studies to confirm if the tumor metastasized or not. The physician decides to do a surgical procedure to excise cancer. The service performs successfully. 

The NPP assists the surgeon in the tumor removal of the lumbar region and actively participates in the entire surgery. NP and physician may bill for the lumbar tumor excision separately, But NPP bills with AS modifier.

Example 2

A 76-year-old male presents to the office for radiculopathy and stenosis of the lumbar region. Denies trauma, heavy palpitations, dizziness, cough, recent illness, fever, chills, back pain, abdominal pain, nausea, recent travel, known sick contacts, current antibiotic use, near-syncope or syncope, changes in stool color, urinary complaints, or any other symptoms.

A patient has had severe low back pain since last week. The patient took some medication for pain, but it is getting worse daily. 

CT scans of the lumbar region revealed spondylosis of the L2-L3 level, disc protrusion at the L4-L5 level, and degenerated changes at the L5-S1 area. The patient requested the physician for pain management as he could not bear it. 

The physician performs surgery at L5-S1 to decompress the nerves, which the NPP assisted, and actively participates in the lumpectomy procedure. NPP bills lobectomy procedure with modifier AS

Example 3 

A 39-year-old male with PMH of thyroid cancer presents to the emergency department with c/o constant neck pain that started four days ago. The patient was unable to eat anything for 1-week.  

The patient is consulted with his primary care physician and suggested to go emergency department. Denies trauma, heavy palpitations, dizziness, cough, recent illness, fever, chills, back pain, abdominal pain, nausea, recent travel, known sick contacts, current antibiotic use, near-syncope or syncope, changes in stool color, urinary complaints, or any other symptoms.

 The patient took his routine medication. The physician ordered a CT scan of the neck’s soft tissues and laboratory studies to see if the cancer was back. The physician then performs tumor excision on the channel with NPP assistance. The NPP bill neck tumor excision with modifier AS.

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