Neurology & Pain Management Coding Alert

Question: Is there a difference in the reimbursement of procedures for modifiers 80 and 82?

Texas Subscriber

Answer: Modifier 80 (Assistant surgeon) only implies that an assistant surgeon was involved in the procedure that the primary surgeon performed.

On the other hand, modifier 82 (Assistant surgeon [when qualified resident surgeon not available]) implies that an assistant surgeon performed the procedure when a qualified resident surgeon was not available. There isn’t a difference between reimbursements for these modifiers.

Your payer may ask for proof that there was no resident surgeon available when you use modifier 82. If you do not justify the need for an assistant surgeon for the reported procedure, your payer may not process your reimbursement. Since the federal government provides hospitals with payment for the services of resident physicians, the role of an assistant at surgery is expected to be provided by the resident in teaching hospitals.

However, in circumstances where a qualified resident is unavailable, an attending may assist at surgery and report modifier 82 to account for this work. 

Tip: Always check to see if the procedure code allows for an assistant, and if it does and you are using 82, make sure you have the documentation ready to show no resident was available.