Description of CPT Modifier 80
To recognize the assistance of a surgical assistant, submit CPT modifier 80.
A physician may help another doctor in conducting a process during certain processes. The operating surgeon’s assistant would reveal the same surgical procedure as the surgical team. The assistant surgeon is normally present during the operational phase or a significant portion of it to help the operating physician. Non-physicians helping at surgery should not use Modifier 80.
When numerous process codes are charged for a surgical discussion, and only some of the principles are qualified for assistant surgeon repayment, only the eligible rules are repaid. The assistant surgeon must reveal the same guidelines as the surgeon. When a surgeon debt a global code, this is an exception (e.g., maternity care). In that case, the surgical assistant must bill the surgical intervention code (e.g., delivery only). Non-physician assistants at surgery services must be forwarded with modifier AS, not 81. Non-physician advisors at surgery services submitted with modifier 81 appended will be repaid at the same rate as those sent with modifier AS attached.
Instructions and Guidelines
This modifier can only be used in conjunction with surgery codes.
A claim for offerings that are Asst Surg Indicator 0 on the Medicare Physician Fee Schedule Database must be accompanied by supporting documents describing the medical reason for an assistant (MPFSDB)
Furthermore, when the surgery is done in a teaching hospital, paperwork to assist one of the following circumstances is required in the medical record:
- A statement stated that no qualified residents were available to conduct the service.
- A statement suggests the presence of exceptional medical circumstances.
- A statement implies that the main surgeon has a strong policy of never implicating residents in their patients’ pre-operative, operative, or postoperative care.
Refer to the MPFSDB to evaluate whether the services of an assistant may be forwarded to Medicare with CPT Modifier 80.
- The database can be accessed straight from the CMS website.
- From the web page’s bottom, select Physician Fee Schedule Search.
- The screen is set to the current year by default—select Payment Policy Indicators from the Type of Information drop-down menu.
- Access the appropriate code after selecting a single set of rules, multiple procedure codes, or a range of principles (s)
- The modifier should be chosen (or select “all modifiers”)
- Refer to the “Asst Surg” column.
- Indicator 0 relates to a payment limit for surgical assistants, which applies to this process. The claim must be accompanied by supporting documents explaining the medical reason for an assistant.
- Indicator 1 corresponds to the statutory payment restriction for surgical assistants, which applies to this procedure. Surgical assistants will not be compensated.
- Indicator 2, which relates to a payment restriction for surgical assistants, does not implement this procedure. Surgical assistants may be compensated.
- Indicator 9 is associated with the concept does not pertain (the most likely explanation is that the procedure is not a surgery).
Modifier 80 Example
Assume two providers (a primary surgeon and an assistant surgeon) are implicated in venous graft procurement. For reimbursement, the main surgeon is revealed with procedure codes 33510 to 33516 in this example. However, when reporting claims for surgical assistants, we must add modifier 80 to procedure codes 33510 to 33516.
When an assistant surgeon is associated with or accomplishes a venous graft, we must attach modifier 80 to reimburse the assistant surgeon’s payment from the insurance provider by indicating that the assistant surgeon was also implicated in the venous graft procurement service. If the claim for the assistant surgeon is submitted to the insurance provider without the addition of modifier 80, the claim will be denied as a duplicate.
We hope that this article has provided you with all of the information you need to use modifier 80 correctly. If you are still unsure and require assistance with medical billing for your practice, please contact us. We have a skilled coding and billing team that employs precise modifiers to ensure accurate insurance reimbursement. To learn more about our medical billing services, please contact us at email@example.com
Billing Executive – a Medical Billing and Coding Knowledge Base for Physicians, Office staff, Medical Billers and Coders, including resources pertaining to HCPCS Codes, CPT Codes, ICD-10 billing codes, Modifiers, POS Codes, Revenue Codes, Billing Errors, Denials and Rejections.
We have more than 10 years experience in US Medical Billing and hand-on experience in Web Management, SEO, Content Marketing & Business Development with Research as a special forte.