Modifier Coding Alert

Question: Our clinic’s doctor was the primary surgeon during a surgery. Our advanced practice nurse prescriber (APNP) assisted. The primary surgeon called in another doctor from another clinic not associated with our clinic. The other clinic billed their doctor’s services with modifier 80. What modifier should I use in this situation?

Virginia Subscriber

Answer: You would attach modifier AS (Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery) to the procedure code to bill your APNP’s services. You may also need modifier 80 (Assistant surgeon) or 82 (Assistant surgeon in a teaching facility) for the APNP, depending on the payer’s requirements. You don’t need a modifier for your physician’s surgical services. However, the documentation must support the services performed by the APNP, as well as the reason why she couldn’t perform the portion of the procedure for which the other provider participated.

All three claims should be reimbursable. The two assistant claims are both payable because the other doctor is from a different clinic and he would have a different tax identification number. His claim will include modifier 80.