Understanding Modifier 82: Assistant Surgeon Services
Introduction
In specific healthcare settings like teaching hospitals, qualified resident surgeons often serve as assistant surgeons alongside the operating surgeon. However, sometimes a qualified resident isn’t available. Modifier 82 comes into play in such situations, indicating an assistant surgeon (physician) who isn’t a qualified resident, this article clarifies its proper usage and eligibility criteria.
Defining “Assistant Surgeon”
An assistant surgeon actively supports the primary surgeon throughout the operation, including:
- Providing full assistance during the procedure.
- Being capable of assuming the surgery if the primary surgeon becomes incapacitated.
Eligible Provider Types
- Physicians: MDs and DOs can utilize modifier 82 when acting as assistant surgeons.
- Non-physician providers: While excluded from using modifier 82, Physician Assistants (PAs), Nurse Practitioners (NPs), and Clinical Nurse Specialists (CNSs) have their own designated modifiers for assistant at surgery services.
Ineligible Provider Types
- Certified First Assistants (CFAs)
- Certified Surgical First Assistants (CSFAs)
- Certified Surgical Assistants (CSAs)
Key Points for Modifier 82
- Unavailability of a Qualified Resident: The core prerequisite for using modifier 82 is the absence of a qualified resident surgeon to assist. This is particularly relevant in teaching hospitals where residents typically fulfill this role.
- Documentation: Clearly document the reason for the resident’s unavailability, such as rotational changes, scheduling conflicts, or medical leave.
- Eligible Codes: Modifier 82 can only be appended to surgery codes, not global codes. When billing multiple procedures, only eligible codes receive reimbursement with modifier 82.
- Reimbursement: The assistant surgeon’s payment depends on the specific procedure and payer policies. It typically ranges from 16% to 85% of the primary surgeon’s fee.
- Who Can Use It: Only professional providers can utilize modifier 82. Hospitals are not eligible.
Examples
- Acceptable: Dr. Smith (MD) acts as an assistant surgeon for Dr. Jones (MD) in a complex orthopedic surgery when a resident surgeon isn’t available due to rotational change. Dr. Smith uses modifier 82 with the relevant CPT code.
- Unacceptable: A hospital bills for an assistant surgeon service using modifier 82. This is incorrect as hospitals cannot use this modifier.
- Unacceptable: A Nurse Practitioner assists in a surgery and uses modifier 82. Modifier 82 is strictly for physicians, and the NP should use the appropriate modifier for their service.
Understanding and applying modifier 82 correctly ensures accurate surgical billing and compliance with regulations. By following these guidelines and consulting relevant resources, healthcare providers can navigate this aspect confidently. If you are unsure and need help in 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 our medical billing services.
References:
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. 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.
