Modifier 82: Appropriate Use
Modifier 82: Assistant Surgeon (when qualified resident surgeon not available)
In certain programs or facilities (e.g., in teaching hospitals), the physician who generally acts as the assistant surgeon is a qualified resident surgeon. There may be times when a qualified resident surgeon is not available to assist the operating surgeon, so a physician assists the operating surgeon in this instance. Modifier 82 is not intended for use by non-physicians assisting at surgery (e.g. Nurse Practitioners, Physician Assistants, Registered Nurse First Assistants, etc.).
When multiple procedure codes are billed for a surgical session and only some of the codes are eligible for assistant surgeon reimbursement, only the eligible codes will be reimbursed. The assistant surgeon must report the same codes as the surgeon. An exception to this is when the surgeon bills a global code (e.g. maternity care). In that case, the assistant at surgery must bill the specific surgery-only code (e.g. delivery only).
Defining ‘Assistant Surgeon’
- Provides full assistance to the primary surgeon
- Capable of taking over the surgery should the primary surgeon become incapacitated
The following provider types eligible for reimbursement for an assistant at surgery services:
- MD (Medical Doctor)
- DO (Doctor of Osteopathic Medicine)
- PA (Physician’s Assistant)
- NP (Nurse Practitioner)
- RNFA (Registered Nurse First Assistant)
The following provider types are not eligible for reimbursement of assistant at surgery service:
- Certified First Assistant (CFA)
- Certified Surgical First Assistant (CSFA)
- Certified Surgical Assistant (CSA)
Additional Billing Information
The prerequisite for using modifier 82 is the unavailability of a qualified resident surgeon. In certain programs (such as teaching hospitals), the physician acting as the assistant surgeon is usually a qualified resident surgeon. However, there are times (such as during rotational change) when a qualified resident surgeon is not available and another surgeon assists in the operation. In these instances, the services of the non-resident assistant surgeon are reported with modifier 82.
Use modifier 82 when the assistant at surgery service is provided by an MD when there is not a qualified resident available. Documentation must include information relating to the unavailability of a qualified resident in this situation. Modifier 82 can only be used by professional providers. It should not be used by a hospital. This modifier can only be submitted with surgery codes. Physician assistants, nurse practitioners, and clinical nurse specialists must not submit this modifier.
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We hope this article would have given you all the necessary information to use modifier 82 appropriately. If you are still not sure and need help in medical billing for your practice, you can always contact us. E2E Medical Billing Services has an experienced billing and coding team that uses exact modifiers to bring accurate insurance reimbursement. To know more about our medical billing services call us at 888-552-1290 or write to us at info@e2eMedicalBilling.com