Name of Manual - Blue Cross and Blue Shield of Minnesota

Coding Policies and Guidelines (Surgical Services)
Assistant Surgeons Almost all Blue Cross members have coverage for assistant
surgeon’s services when the following criteria are met:
11-10
The surgical assistant is a licensed physician, nurse practitioner
(NP), registered nurse first assistant (RNFA), or physician
assistant (PA).
The surgical assistant’s services are medically necessary. (This
is determined by the complexity of the surgery.)
Note: Assist at surgery services rendered by Surgical Techs or
Bachelor of Medicine and Bachelor of Surgery (MBBS)
practitioners are not allowable. Assistant surgery services rendered
by these specialties will be denied as an ineligible provider.
To bill services of an assistant surgeon (MD, NP, PA, or RNFA
acting as an assistant at surgery); use the surgical procedure code
with modifier -80.
The modifiers -81, 82 or –AS may also be used for assist services.
Modifier –AS specifically designates the assist as a physician
assistant, nurse practitioner or clinical nurse specialist.
If more than one surgical procedure was done during the same
session, list each procedure separately.
Generally, reimbursement for eligible assistant surgeon services is
16 percent of the surgery allowance. When an assistant surgeon is
involved in multiple surgical procedures, the same method used for
determining reimbursement for the primary surgeon shall be used
in determining reimbursement for the assistant surgeon. The
secondary surgeries will be subject to an additional multiple
surgery reduction (50 percent), if appropriate.
We do not publish a list of surgeries for which an assistant surgeon
is allowed. Generally, we follow the list that CMS has furnished to
Medicare carriers, for approved codes. However, we may subject
the assist services to additional edits or restrictions. Denied
assist-at surgery claims may be appealed with documentation. The
documentation/operative report should identify the assistant,
credentials, and should include the involvement, thus need, for the
assistant.
Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (03/19/12)