Billing As A First Assist

[core0]

Nolagrace1202 said:

If I practice as an APRN for a surgeon and help him as a first assist in surgery, how much money do you think it would add to my income?

Does anyone work in this capacity? Can you describe your role? Thanks!

Its a little more complicated than that. Generally if assist is part of the job it doesn't add to the salary. Instead if you don't assist and they have to find another assist the salary is less. This is why a lot of academic surgery jobs pay less (residents do the assist).

Generally for surgery there are three parts to the job.

1. Consults and preop work. The consults are reimbursed but preop work in usually bundled into the surgery fee. Whether some of that income is credited to the APP depends.

2. Assist at surgery. For Medicare the assist fee for APPs is 14.5% (85% of the 16% physician assist fee). Medicaid and other insurances will pay less or more. Then you have to determine if the surgery reimburses a first assist fee.

The neurosurgery codes start around 60000. If they do a lot of spinal simulators then there isn't any first assist reimbursement. On the other hand if they do a lot of spine surgery there is.

3. Follow up inpatient and in the office. This is again usually bundled into the global surgery fee. However, if the APP is doing this work, it frees up the physician to do more consults or surgeries that don't require an assist.

As for the money, here's how it works.

For example CPT 63001 for a lumbar laminectomy (there are many codes for this depending on what else is going on but I chose this for demonstration).

The work RVU (RVU for physician work) for this is 17.61 wRVUs for the surgeon. Medicare reimburses around $31 per RVU. So the surgeons fee would be $545. The assist fee would be $79. As you can see here the assist fee would barely cover the salaries + benefits. On the other hand a multi level lumbar laminectomy with hardware will have a surgeons fee over $8000 and the assist fee will be over $1000.

So fundamentally it does't really add to your income although it should be baked into the salary. Now some practices will reward APPs for being more productive ie. Extra money for RVUs over a certain amount. Another way is to reward call and late hours. For example one practice gives the APPs 100% of the RVUs when on call or after 5pm.

On the other hand if you have to take call and an uninsured patient comes in you are working for free. Also remember the average neurosurgery hours are around 55-60 hours per week. Lots of call and late nights. There is a reason neurosurgery salaries are high.

[delawaremalenurse]

Are you a RNFA already or working on receiving this certification?

[Nolagrace1202]

I would start the coursework for my certification next month

[Nolagrace1202]

I'm considering accepting a position for a neurosurgeon who wants me to have my first assist certification and complete a 6 month fellowship. I am trying to figure out whether its something I should be able to bill for separately or will I have to negotiate it as part of my salary. The fellowship is in its creation stage so they aren't able to provide me with any tangible details, so I am reaching out here for anyone's experience or info...