Hint: Do not report modifiers 80 and AS together. An assistant surgeon may be necessary to help perform a surgical procedure, but adding the details to the operative report can be complicated. And that includes using the correct modifiers to ensure your claims are clean. Check out this guide to learn how to append assistant at surgery modifiers. Understand When an Assistant Surgeon Is Necessary According to Medicare guidelines, an assistant at surgery is “a physician who actively assists the physician in charge of a case in performing a surgical procedure.” A primary surgeon may require an assistant surgeon during a procedure for several reasons, including the complexity of the procedure or a patient having multiple comorbidities that could complicate the treatment. In those cases, the assistant surgeon works under the primary surgeon’s direct supervision.
“Medicare requires the primary surgeon to list the assistant surgeon in the operative report, and make some notation within the procedure description regarding how the assistant was involved,” explains Terri Brame Joy, MBA, CPC, COC, CGSC, CPC-I, product manager, MRO, in Philadelphia. Your coding will depend on which surgeon you’re reporting on the claim. If you’re reporting the procedure for the primary surgeon, you’ll assign the correct procedure code without an assistant surgeon modifier. However, you’ll append an applicable modifier to the same procedure code when you’re billing for an assistant surgeon. Master the Assistant Surgeon Modifiers The CPT® code set features three assistant-surgeon modifiers: Choosing between modifiers 80 and 81 comes down to the assistant surgeon’s involvement in the surgery. You’ll append modifier 80 if they participate in the entire procedure, but you’ll use modifier 81 when the assistant surgeon assists with a portion of the operation. Payment is not allowed for assistants at a surgery when it is furnished in a teaching hospital that has a training program related to the medical specialty required for the surgical procedure and has a qualified resident available to perform the service. If a qualified resident isn’t available in a teaching facility, which means the assistant surgeon has to perform the entire procedure, then the physician must document the unavailability in the operative note, and you’ll append modifier 82 to the applicable CPT® code. According to the Medicare Claims Processing Manual, CMS lists several ways the qualified resident isn’t available, which include: Analyze the Specific Modifier AS Use Circumstances Medicare will pay for an assistant surgeon when an assistant is authorized for the procedure. However, the provider performing the assistance must be a physician, physician assistant (PA), nurse practitioner (NP), or a clinical nurse specialist (CNS). In procedures where a PA, NP, or CNS assists during the surgery, you’ll append HCPCS Level II modifier AS (Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery) to the surgery code. When the healthcare professionals listed above act as surgery assistants, make sure you do not include modifier 80, too. Why? According to the following Medicare Claims Processing Manual sections, only modifier AS will be reported on the claim: As always, you should review your individual payer preferences to check how they want billing for surgical assistants. Many commercial payers follow Medicare’s billing rules, but not all of them do. Some payers may want modifier AS, while others may not recognize it entirely.
Find out if the Procedure Allows Assistant Surgeon Billing Billing for an assistant at surgery for Medicare reimbursement requires more than just appending the correct modifier. The Medicare Physician Fee Schedule (MPFS) features an assistant surgeon (Asst Surg) column that indicates if a procedure allows an assistant. The indicator listed in the column will let you know the reimbursement rules for the procedure: Payers won’t reimburse for assistants at surgery in every surgical case, even if you append 80, 81, 82, or AS to the claim. Medicare guidelines state that assistant at surgery services are eligible for reimbursement only when the procedure would require an assistant in 5 percent or more of claims submitted nationally.