Wiki modifier 80 - assistant surgeon

[Anne Sleighter]

I need some help here. I have always billed an assistant surgeon with modifier 80 as instructed, my problem is what do I do with the fee? Do I bill the reduced fee? Or as my administration is telling me, bill the full fee, insurance pays their portion of the reduced fee (the insurance reduces it). Then do I bill the patient their remaining amount? I just received an EOB that left pt responsibilty for the remainder of the full fee. This just doesn't feel right.

 

[sande78705]

Asst surgeon

When i bill an 80 with a procedure, i enter the exact same information as the primary surgeon along with amt they charge, the insurance co will amke the appropriate reduction.
Suzanne

 

[mhstrauss]

I need some help here. I have always billed an assistant surgeon with modifier 80 as instructed, my problem is what do I do with the fee? Do I bill the reduced fee? Or as my administration is telling me, bill the full fee, insurance pays their portion of the reduced fee (the insurance reduces it). Then do I bill the patient their remaining amount? I just received an EOB that left pt responsibilty for the remainder of the full fee. This just doesn't feel right.

I agree that it is not right to charge the patient the difference between what was allowed for the asst and what was charged, based on primary surgeon's fee. We reduce asst's fee to 25% of primary surgeon's charge amt. Assistants are typically paid 15%-25% of the primary's fee, so by going with 25, you aren't taking the risk of missing reimbursement, while also not sticking the patient with a ridiculous amount.

HTH!

 

[j.monday7814]

we reduce the amount to 18% of our original charge amount which is already double the Medicare fee schedule. Obviously, Medicare reimburses at 16% of the fee schedule for modifier 80 so we figured billing 18% of our charge amount was best. I've not seen an EOB where the patient gets stuck with the balance but that definitely isn't right.