Understanding Assistant Surgeon Modifiers

Introduction

This article provides an overview of assistant surgeon modifiers and assistant at surgery services, drawing on current regulations and best practices. 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.

Who is an Assistant Surgeon?

An assistant surgeon is a physician (MD or DO) who actively assists the primary surgeon during a surgical procedure. They provide more than just basic assistance and are capable of taking over the surgery if needed.

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 assist 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 required 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 members. Therefore, for Medicare reporting purposes and as directed by a commercial third-party payer, 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.

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

We hope this article has given you all the necessary information required to use assistant surgeon modifiers appropriately. If you are still not sure and need help with medical billing for your practice, you can always contact us. PrimeCare has an experienced billing and coding team that uses exact modifiers to bring accurate insurance reimbursement. Contact us today to learn more about medical billing services.

The American Medical Association (AMA) holds the copyright for the Current Procedural Terminology (CPT®) codes and their associated modifiers, including those mentioned in this article (modifiers 80, 81, 82, and AS). The use of these codes and modifiers is governed by the AMA’s Current Procedural Terminology (CPT®) Coding Rules and the Healthcare Common Procedure Coding System (HCPCS) guidelines. This information is intended for educational purposes only and does not constitute legal or medical advice.