# Billing modifier 22 on assistant surgeon claim



## wmiller

When billing a surgery that was a significantly increased procedural service on an assistant surgeon claim (physician) would you bill the CPT code with -80-22 or the CPT code with -22-80?


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## surgonc87

I think it depends on your billing system, if it is to calculate things for you...but, we append mod 22 then 80 or 82.  22 is whats going to increase the procedure, then 80 is saying i helped out, pay me some after the increase....lol


MS


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## cwpierce

I was reviewing my textbook for my upcoming CPC exam and according to the 2010 Step by Step Medical Coding book p. 250.... "When there are multiple CPT modifiers assigned to one code, list the modifiers from highest to lowest. For example, -78-50."

CP


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## mitchellde

cwpierce said:


> I was reviewing my textbook for my upcoming CPC exam and according to the 2010 Step by Step Medical Coding book p. 250.... "When there are multiple CPT modifiers assigned to one code, list the modifiers from highest to lowest. For example, -78-50."
> 
> CP



I think they mean from the highest paying to the lowest.  Put the modifier first that will yield the highest dollar.


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## cwpierce

Thank you for the clarification Debra. Sometimes even our tools can be a bit misleading. Unfortunately, the book is not very clear about highest to lowest as far as meaning numerical value or dollar value.


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## wmiller

In our practice, modifiers 80 and 20 are percentage based.  So it's not going to make a lick of difference to the billed amount, or paid amount, which comes first.  
My initial thought was that you would put the 80 first to let the payer know that it was an assistan surgeons claim, then the 22 to let them know it was difficult.  
Another point of view I've heard is that you want the assistant claim to match the surgeon claim, so you would have to put the 22 first.


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