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POLICY(Effective January 1, 2010)
Effective January 1, 2010, Blue Cross & Blue Shield of Mississippi (BCBSMS) will begin providing benefits for assistant at surgery services when rendered by registered nurse first assistants (RNFA) with a CNOR certification in addition to our current providers; physician assistants (PA), certified registered nurse first assistants (CRNFA) and nurse practitioners (NP). The Company will allow 10% of the allowable charge for the primary, add-on (Appendix D of the CPT manual), and modifier -51 exempt procedures (Appendix E of the CPT manual). Secondary and bilateral procedures will be reimbursed at 5% of the allowable charge for the surgical procedure.
Nurse and PA surgical assistants will be covered for the same list of surgical procedures that MD/DO (i.e., modifiers 80 and 82) surgical assistants are covered.
This new benefit for nurse and PA surgical assistants will be applicable to the following lines of business:
Note: This benefit will not be applicable to members of some self-funded groups.
NEW CODING AND CLAIMS FILING GUIDELINES FOR NURSE AND PA SURGICAL ASSISTANTS
Effective January 1, 2010, modifier -AS (physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery) is required when filing for assistant at surgery services performed by physician assistants, registered nurse first assistant with a CNOR certification, certified registered nurse first assistants and nurse practitioners. Modifier -AS should be appended to the primary procedure, "add-on" and modifier -51 exempt procedures. When assistant at surgery services are performed for multiple and bilateral procedures, modifier -AS should be appended along with modifier -50 or -51, whichever is applicable. Modifier -AS should always be filed in the first modifier position in the electronic professional claim format. Modifier 50 and 51, when applicable, should be filed in the second modifier position.
Providers (physician assistants, registered nurse first assistant with a CNOR certification, certified registered nurse first assistants and nurse practitioners) filing modifier ?AS will be required to obtain a BCBSMS provider identification number in order to submit claims for reimbursement.
Assistant at surgery services should be filed to BCBSMS on a separate claim form from the primary surgeon's services. All services should be filed using the assistant surgeon's BCBSMS provider identification number and the National Provider Identifier number. BCBSMS will not accept modifier -AS for dates of service after January 1, 2010 on the same claim form as the primary surgeon's claim. Any claims with dates of service after January 1, 2010 that contain modifier -AS on the same claim form as the primary surgeon's claim will be rejected/returned to the provider for correction. Additionally, any claims with dates of service after January 1, 2010 without a BCBSMS provider identification number will be rejected/returned to the provider for correction via the EDI reject report.
POLICY GUIDELINESThe coding guidelines outlined in Coding Policy should not be used in lieu of the Member's specific benefits plan language.
POLICY HISTORY7/2004: Policy developed
1/1/2010: Policy revised to indicate that registered nurse first assistants (RNFA) with a CNOR certification are now eligible for the assistant surgeon benefit. Clarification that certified first nurse assistant (CNFA) should be certified registered nurse first assistant (CRNFA). Filing guidelines revised to indicate that assistant surgeons will no longer file on the same claim form as the primary surgeon?s claim and the assistant surgeon must obtain and file with their BCBSMS provider identification number. The assistant surgeon should submit a separate claim form from the primary surgeon. Added most self-funded groups are subject to this policy.
9/2/2010: Removed statement regarding modifier -81 (minimum assistant surgeon).