Modifier 81: Appropriate Use
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 (use modifier AS). Modifier 81 is a processing modifier, and the rate is 25% of the base code. All services, if an assistant surgeon is allowed, are subject to multiple surgical reductions and bundling software edits. Medical records are not required with the claim, but must be available upon request.
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)
- Append to appropriate code when more than one assistant is involved or if one person assists during a portion of surgery. Includes physicians providing minimal assistance to primary surgeon.
- Modifier 81 indicates exceptional medical circumstances exist
- Modifier 81 indicates primary surgeon has policy of never involving residents in preoperative, operative or postoperative care of his/her patients
Additional Billing Information
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.
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We hope this article would have given you all the necessary information to use modifier 81 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