Modifiers give you more control over reporting the provided services precisely. However, this additional detailing in medical coding can also be stressful since there are many modifiers with minute differences. Even if we talk about reporting the services of an assistant at surgery, there are several modifiers to choose from, such as 80, 81, 82, and AS.
Thus, our billing and coding specialists at MediBillMD decided to give you a head start by dedicating this specific guide to modifier 80. This guide will cover everything that you need to know, from the applicable scenarios to accurate usage guidelines and how it differs from modifier 82.
So, if you are a healthcare provider who assists in surgical procedures, we recommend you read it till the end!
Modifier 80 – Description
When one physician assists another healthcare practitioner in performing a surgical procedure, the physician lending a helping hand to the operating surgeon will report the same procedural CPT code as the primary surgeon. However, modifier 80 will be appended to the code to identify the services of an assistant surgeon.
The assisting physician should be present during the entire or a substantial portion of the surgery to assist the operating physician. Besides, this modifier should not be used if a non-physician practitioner (NPP), such as a registered nurse first assistant, nurse practitioner, physician assistant, etc., assists with the surgery.
Modifier 80 – Examples
Here are some illustrative scenarios to help better understand modifier 80’s application:
Robotic-Assisted Prostatectomy Surgery
Let’s assume that during a robotic-assisted prostatectomy surgery, two surgeons were involved. The primary surgeon controlled the robotic arms. On the other hand, the assistant surgeon assisted with tissue retraction and dissection, providing real-time feedback and manipulating instruments within the patient’s body.
Thus, the assistant surgeon will apply modifier 80 to the claim since the provider played a crucial and active role in this surgical procedure.
Complex Laparoscopic Cholecystectomy
Consider a complex laparoscopic procedure in which the primary surgeon encounters significant adhesions from previous abdominal surgery. Thus, the complications of the case demand the assistant surgeon’s active participation and continuous support in managing bleeding and retracting tissue. As a result, the assistant surgeon should append modifier 80 to the medical claim to receive rightful reimbursements for the crucial support provided during the surgery.
Major Orthopedic Surgery
What if an assistant surgeon offers continuous support during a total hip replacement surgery, including bleeding control, tissue retractions, and assisting in bone preparation and implantation? The critical role of the assistant surgeon and the complexity of the procedure warrant the application of modifier 80.
Accurate Usage Guidelines for Modifier 80
The scenarios we discussed above may have given you an idea of which situations require the use of this modifier. However, there is more to this. Therefore, in this section of the guide, we will share some rules to help you ensure accurate usage of modifier 80. So, without further ado, let’s get started!
Use When the Assistance Lasts Most of the Surgery
Append this modifier when a physician assists the operating physician throughout the entire or a significant portion of the surgical procedure.
Should Not Be Used for Non-Physician Assistance
Do not use modifier 80 if the healthcare professional assisting the primary surgeon is a non-physician, as it may result in claim denial due to the wrong modifier because for reporting the services of a non-physician, modifier AS is available.
Refer to MPFS for Medicare Claims
If you are billing Medicare for the services of an assistant surgeon, check the assistant surgeon (Asst Surg) column in the Medicare Physician Fee Schedule (MPFS), which indicates whether a procedure allows reimbursement for such services. Here’s what each indicator entails:
Indicator 0
Medicare will reimburse with this modifier only if the documentation successfully establishes the medical necessity of an assistant at surgery.
Indicator 1
Avoid appending modifier 80 to procedural codes with this indicator, as Medicare does not allow reimbursement for an assistant at surgery.
Indicator 2
Medicare allows payment for the services of an assistant surgeon for these procedures, so you should append modifier 80 to ensure rightful reimbursement.
Indicator 9
The concept of using the services of an assistant surgeon does not apply to these procedures.
Note that if you are dealing with commercial payers, the guidelines for appending this modifier will vary. Thus, we recommend communicating with the payer before submitting a claim to ensure timely payment.
Modifier 80 vs 82 – Understanding the Difference
Are you confused between modifiers 80 and 82? Don’t worry, because the table below will provide the needed clarity.
| Modifier 80 | Modifier 82 | |
|---|---|---|
| Focus | Append this modifier when the healthcare practitioner provides full assistance to the primary surgeon during surgery. | Add this modifier when a qualified resident surgeon is unavailable to assist during a surgical procedure. |
| Application | It may apply in various clinical settings, including private practices and community hospitals. | It is primarily applicable in teaching hospitals with resident training programs. |
Modifier 82 is typically appended to report to the insurance payer that a qualified resident surgeon is unavailable in a teaching hospital setting. In contrast to modifier 82, modifier 80 has a broader scope, encompassing any surgical procedure in which a physician provides significant and continuous assistance to the primary surgeon.
However, there are some similarities. For instance, both modifiers are used to report the services of an assistant surgeon during surgery, allowing reimbursements at 16-20% of the primary surgeon’s billable amount (the rate may vary depending on the different payer reimbursement guidelines).
Summary
Any guide can be overwhelming when you reach the end, as there are too many details to follow and remember. Let’s quickly revisit the key points we discussed to refresh your memory! We explained that modifier 80 should be used to report an assistant surgeon’s services for most or all of the surgery. We also shared some practical examples.
However, we knew more details were needed to equip you with the necessary knowledge while reporting modifier 80. So, we delved into the accurate billing guidelines related to this modifier. These included checking the indicator value in MPFS, verifying that the provider was not a non-physician, and ensuring that the assistance was provided throughout or during a significant portion of the surgical procedure.
