Orthopedic Coding Alert

Question: When billing for assistant surgeons fees, should I charge full price for the assistant and allow the insurance company to cut the fees, or reduce the fees first?

Delaware Subscriber

Answer: With the amount of reductions already taking place in managed care, practices that discount their fees prior to submitting claims are self-defeating. Always charge the full fee and let the carrier determine the reduction. Charge 100 percent for the assistant surgeon with modifier -80 (assistant surgeon) appended, and let the carrier determine the amount of reduction. Certain carriers may deny the assistant's claim as a duplicate, since both surgeon and assistant are submitting for the same procedure. When this happens, file the surgeons claim first and wait until that is paid to submit the assistant's charge.