Otolaryngology Coding Alert

Question: Two otolaryngologists work at the same clinic. One assists the other in a procedure. I know modifier -80 applies, but I have two other questions: (1) How much do I charge for the procedure? and (2) Do both surgeons require an operative report?

Florida Subscriber

Answer: Both surgeons bill separately for the session, says Ann Hughes, CPC, a practice coder with Mid-Vermont ENT in Rutland, Vt. The assistant surgeon should append modifier -80 (assistant surgeon) to the appropriate CPT procedure code. Unlike a co-surgery situation, however, a separate operative report is not required.

Although all carriers significantly reduce assistant surgery fees, Hughes bills these claims at 100 percent. Medicare pays an assistant surgeon 16 percent of the full fee, but some private payers may pay as high as 25 percent, she says. Therefore, to avoid underbilling some payers, she recommends billing the full fee and allowing the carrier to reduce payment according to its own policy.

Some coding specialists bill assistant surgery at 50 percent and work backward from there until the amount paid by the carrier is known, says Susan Callaway, CPC, CCS-P, a coding and reimbursement specialist and educator in North Augusta, S.C.