Orthopedic Coding Alert

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

Virginia 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 full fee and let the carrier determine the reduction. Charge 100 percent for the assistant surgeon with modifier -80 appended, and let the carrier determine the amount of reduction. Certain carriers may deny the assistants claim as a duplicate, since both the 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 assistants charge.