Wiki Surgery Assistant question

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msrainbird

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One of my providers assisted during a mastectomy. This is a first for me and I need your help. I was given three codes by the surgeons office 19301, 38525 & 19307 that they billed out. I know I need to use a modifier 80 but need to know 1. if I attach it to all three codes since my provider assisted during the whole surgery 2. do I charge the regular Medicare rate for these or do I adjust it down since we only assisted?

I appreciate any help you can give me as this is way out of my area
 
msrainbird said:
One of my providers assisted during a mastectomy. This is a first for me and I need your help. I was given three codes by the surgeons office 19301, 38525 & 19307 that they billed out. I know I need to use a modifier 80 but need to know 1. if I attach it to all three codes since my provider assisted during the whole surgery 2. do I charge the regular Medicare rate for these or do I adjust it down since we only assisted?

I appreciate any help you can give me as this is way out of my area
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1. Not all codes are recognized as requiring an assistant surgeon - this varies from payer to payer. Your best choice is to apply the modifier to the codes and submit for reimbursement. (Unless of course they aren't surgical codes :)

2. Submit the regular charge (the payer will adjust the reimbursement accordingly using the appropriate percentage.)
 
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