Otolaryngology Coding Alert

Question: How do I find out if I can bill a procedure with an assistant surgeon?

Washington, D.C., Subscriber

Answer: Look at column AA of the 2008 Medicare Physician Fee Schedule (which you can find at http://www.cms.hhs.gov/PhysicianFeeSched/PFSNPAF/list.asp?listpage=3).

A "2" in the column means the surgery allows payment for an assistant. A "0" means you might get paid, but you-ll have to submit documentation showing the medical necessity for the assistant. A "1" is a no-go, indicating "Assistant at surgery may not be paid," according to Medicare.

Remember: The main surgeon will report the CPT code without a modifier and should identify the assistant's presence and the work he performed within the op note. A second op report is not necessary. The assistant reports his work and bills for his services by adding an assistant surgeon modifier to the procedure code(s) performed.

Modifiers that may apply include:

- Modifier 80: Assistant surgeon for an MD or DO assisted on the majority of the case (Medicare pays at 16 percent)

- Modifier 81: Minimum assistant surgeon for an MD or DO assisted on less than the majority of the case

- Modifier 82: Assistant surgeon (when qualified resident surgeon not available) in an academic institution for a physician assistant (PA), nurse practitioner (NP), or clinical nurse specialist (CNS) when no qualified resident is available

- Modifier AS: Medicare modifier for a PA, NP or CNS who is an assistant at surgery (Medicare pays at 13.6 percent).