Modifier 80: Appropriate Use
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. Modifier 80 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). Non-physician assistant at surgery services are to be submitted with modifier AS appended, not modifier 81. Non-physician assistant at surgery services submitted with modifier 81 appended will be reimbursed at the same rate as if submitted with modifier AS appended.
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)
Example of Modifier 80
Let us assume providers (Primary surgeon and Assistant surgeon) involved to perform venous graft procurement. In this example primary surgeon is reported with procedure code 33510 to 33516 for reimbursement. But when it comes for reporting the claim for surgical assistant, then we need to add modifier 80 to procedure code 33510 to 33516.
It means when assistant surgeon involves or performs venous graft, we need to append modifier 80 to reimburse the payment of assistant surgeon from the insurance company by indicating assistant surgeon also involved while performing the venous graft procurement service. If the claim is reported to the insurance company for assistant surgeon without appending modifier 80, then the insurance company will deny the claim as duplicate. Because the same service will be reported by primary surgeon to insurance company in order to reimburse the payment for his service. Same like that when surgical assistant performs arterial and or venous graft procurement, add modifier 80 to 33517-33523, 33533-33536 as appropriate to reimburse the payment of assistant surgeon when performed.
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We hope this article would have given you all the necessary information to use modifier 80 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]