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Pulmonology Coding Alert

Reader Questions:

Column AA Shows if Assistant Is Allowed

Published on Mon Aug 11, 2008

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 thoracic surgeon reports the CPT code without a modifier and should identify the assistant's presence and the work he performed within the op note instead of submitting a second op report. 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)
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