Ms. Kerr is a physician assistant at Parkland Urology in Dallas.
A surgical first assistant plays an integral role in the surgical team. Physicians have several options for how to fill and use the position. An option that should be considered is utilizing a physician assistant (PA) as a first assistant. As a PA myself, I feel it is important that physicians are aware of this option and understand its benefits.
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There are many options for a surgical first assist, including an another physician, a fellow or resident physician, a PA, surgical assistant-certified (SA-C), and registered nurse first assistant (RNFA).
Why should you consider using a PA as your first assist? Here are some reasons:
- PAs first assisting at surgery are usually reimbursed at 85-100% of the first-assist fee paid to a physician acting as the first assistant (which is generally 16% of the primary surgeon fee).
- PAs bill for their services at the full physician fee schedule. They should use their national provider identifier number and the “AS” surgical assistant billing modifier. The Medicare carrier or Private payer will implement the appropriate discount. For more information, see the Medicare Claims Processing Manual, Chapter 12, Section 110.3 or Private payer manual.
- Using a PA as a first assist will free up a physician to schedule more surgeries or see more clinic patients, thereby generating more revenue and decreasing patient wait times.
- PAs who first assist are better familiarized with the perioperative and intraoperative care of patients, allowing them to provide more comprehensive patient education and care in the preoperative and postoperative setting.
- Many PAs desire a multifaceted working environment. Encouraging professional development and growth by perfecting a new skill can boost morale and job satisfaction. Varying the PA’s schedule with clinic, procedures, inpatient work, and OR time can be very rewarding. Job satisfaction will help with employee recruiting and retention leading to less turnover.
When can you use a PA as a first assist?
PAs are eligible for reimbursement for first assisting in any procedure where a physician would receive such reimbursement (American Association of Physician Assistants)(CMS).
You may also consult the Physicians as Assistants at Surgery 2016 Update , which assigns all surgeries with CPT codes a ranking of whether or not they require a physician as a first assistant: 1 - almost always, 2 - almost never, or 3 - some of the time. There is also an excerpt called “Surgical Assistants” from the American College of Surgeons Statements on Principles regarding the qualifications of surgical assistants, including non-physician providers.
In teaching hospitals, Medicare restricts coverage of PAs for first assisting at surgery. There are no restrictions for other services PAs provide. If a teaching hospital has an approved and accredited surgical training program related to the surgery being performed and has a qualified resident available to perform the service, no reimbursement is made for a PA first assisting.
If the primary surgeon has a policy of never allowing residents to act as assistants, or in trauma cases, or if the surgeon believes that the resident is not the best individual to perform the service, Medicare will reimburse for a PA first assistant. In these cases, claims should be accompanied by an explanation that the first assist was medically necessary and that no qualified resident was available to first assist at that time. Medicare requires the following attestation in the operative report:
“I understand that section 1842(b)(7)(D) of the Social Security Act generally prohibits Medicare physician fee schedule payment for the services of assistants at surgery in teaching hospitals when qualified residents are available to furnish such services. I certify that the services for which payment is claimed were medically necessary and that no qualified resident was available to perform the services. I further understand that these services are subject to post-payment review by the Medicare carrier.”
For more information regarding PAs assisting in Teaching Settings, see the Medicare Claims Processing Manual Chapter 12, Section 100.1.7.