Assistant Surgeon Modifiers
Assistant at Surgery
An ‘assistant at surgery’ is a physician/non-physician practitioner (NPP) who actively assists the physician in performing a surgical procedure. The ‘assistant at surgery’ provides more than just ancillary services. Documentation for an assistant at surgery services includes helpful information to assist providers inappropriately documenting medical necessity for assistant-at-surgery services. Now let’s look at the description of assistant surgeon modifiers i.e. 80, 81, 82, and AS.
Assistant Surgeon Modifiers
Modifier 80: Assistant Surgeon
During certain operations, one physician assists another physician in performing a procedure. The physician who assists the operating surgeon would report the same surgical procedure as the operating surgeon. The assistant surgeon generally is present during the entire operation or a substantial portion of the operation to provide assistance to the operating physician. This modifier is not intended for use by non-physicians assisting at surgery (e.g. Nurse Practitioners, Physician Assistants, Registered Nurse First Assistants, etc.).
Modifier 81: Minimum Assistant Surgeon
Although a primary operating physician may plan to perform a surgical procedure alone, during the operation circumstances can arise requiring the services of an assistant surgeon for a relatively short time. In this instance, the second surgeon provides minimal assistance, for which he or she reports the surgical procedure code with modifier 81. Modifier 81 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 (see modifier AS)
Modifier 82: Assistant Surgeon (when qualified resident surgeon not available)
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.
Modifier AS: Non-physician Assisting at Surgery
Medicare has established the AS modifier to report Physician Assistant (PA), Nurse Practitioner (NP), or Clinical Nurse Specialist (CNS) services for assistant-at-surgery, non-team member. Therefore, for Medicare reporting purposes and as directed by a commercial third-party payor, to indicate PA, NP, or CNS services for assistant-at-surgery, HCPCS modifier AS would be appended to the usual procedure number instead of one of the CPT modifiers.
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)
CMS Assistant Surgeon Indicators
The codes are eligible/billable for assistant surgeons based on the ‘Assistant Surgeon’ indicator in the current CMS National Physician Fee Schedule as follows:
- ‘0’: Payment restriction for assistants at surgery applies to this procedure unless supporting documentation is submitted to established medical necessity
- ‘1’: Statutory payment restriction for assistants at surgery applies to this procedure. Assistant at surgery may not be paid
- ‘2’: Payment restriction for assistants at surgery does not apply to this procedure. Assistant at surgery may be paid
- ‘9’: Concept does not apply
CPTs and Modifiers © Copyright 2021 American Medical Association
We hope this article would have given you all the necessary information required to use assistant surgeon modifiers 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 [email protected]