| |
| |
|
|
Billing for Assistant Surgeon Services (Article 14) |
|
An assistant surgeon—for TRICARE purposes—includes any physician, dentist, podiatrist, certified physician assistant (PA), nurse practitioner (NP) or certified nurse midwife, acting within the scope of his or her license, who actively assists the operating surgeon in the performance of a TRICAREcovered surgical service. Note that this definition requires an “active” assist with the procedure or service, not just a passive presence.
TRICARE covers assistant surgeon services when the services are considered medically necessary and meet the following criteria:
|
|
-
The complexity of the surgical procedure warrants an assistant surgeon rather than a surgical nurse or other operating room personnel.
-
Interns, residents or other hospital staff are unavailable at the time of the surgery.
-
All assistant surgeon claims are subject to medical review and need verification that the surgical procedure(s) performed required the services of an assistant surgeon and were medically necessary.
-
Standby assistant surgeon services are not reimbursed when the assistant surgeon does not actively participate in the surgery.
|
|
How to Bill Properly for Timely Payment |
|
To ensure timely payment, be sure to complete Box 24D on the CMS-1500 claim form with the modifier that best describes the assistant surgeon services.
|
|
Billing PA and NP Services |
|
When a provider bills for a procedure or service performed by a PA, TRICARE policy requires that the supervising or employing physician bill the procedure or service as a separately identified line item (e.g., PA Office Visit) and use the PA’s provider number. The supervising or employing physician of a PA must be an authorized TRICARE provider. NPs may bill on their own behalf and use their NP provider number for procedures or services they perform.
|
|
| Modifier |
Description |
| Modifier 80 |
Used to designate that the assistant surgeon provided service in a facility without a teaching program. |
| Modifier 81 |
Used to designate a “minimum assistant surgeon.” Typically used when the services provided are only required for a short or discreet time period during the procedure. |
| Modifier 82 |
Used by the assistant surgeon when a qualified resident surgeon is not available. |
|
|
|
|
Back to Top
|
|
|
|
Health Information Privacy (Article 15)
|
|
Notification Requirement |
|
In accordance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and Section C9.3.1.2 of DoD 6025.18-R, “DoD Health Information Privacy Regulation,” January 2003, this serves as notification of the availability of the Military Health System (MHS) Notice of Privacy Practices.
As of April 14, 2003, health care plans and providers are required to provide patients with a Notice of Privacy Practices. The notice describes how patient medical and dental information may be used and with whom it may be shared. It also describes patients’ rights and how to file a complaint if those rights have been violated.
Please take a moment to review the MHS Notice of Privacy Practices and share it with your patients. It is important that patients are fully aware of how their health information can be used and disclosed.
The notice is available in multiple languages. To obtain a copy:
|
|
- Go to the TRICARE Web site and click on “Notice of Privacy Practices” in the right-hand navigation bar.
- Mail a written request to:
|
|
TRICARE Management Activity, Privacy Office
Five Skyline Place, Suite 810
5111 Leesburg Pike
Falls Church, VA 22041-3206
|
|
Back to Top
|
|
Last Reviewed: February 2, 2007
|
|
|
|
|
|
