Do you report the involvement of an assistant surgeon? If not, you could be missing out on rightful reimbursements! Many practices fail to report surgical assistance properly. The primary reason? Limited understanding of modifiers!
That’s where the ‘Assistant at Surgery’ modifiers come in, highlighting the involvement of a physician or other qualified professional in a procedure alongside a primary surgeon. Modifier 82 is one of them. However, unlike general assistant surgeon modifiers, it has a specific requirement of explaining why a physician was involved instead of a qualified resident surgeon.
Let’s explore modifier 82 in detail so you can understand what it means and when to use it to receive proper payments.
Modifier 82 – Description
So, what exactly does this modifier communicate? It tells payers that an attending physician assisted in surgery because no qualified resident was available. Simply put, it highlights that the primary surgeon had no choice but to involve an assistant surgeon.
At first glance, modifier 82 may seem similar to modifier 80 (Assistant Surgeon). However, there is a key difference. Modifier 82 requires documentation explaining why a resident couldn’t assist. Moreover, it is typically used in teaching hospitals.
Modifier 82 – Examples
Here are a few applicable examples of modifier 82 to help you understand it better:
Reporting Assistant Surgeon’s Involvement in Sacroiliac Joint Fusion
Suppose a 34-year-old woman with arthritis suffers from severe sacroiliac (SI) joint pain. She visits the nearest teaching hospital for pain relief. After assessing her condition, the surgeon decides to perform a minimally invasive sacroiliac joint fusion (CPT code 27279) with the help of a co-surgeon.
However, the surgeon gets assistance from the physician instead due to the unavailability of a resident surgeon. Hence, the billing team applies modifier 82 to CPT code 27279 to indicate that an assistant surgeon was involved because a qualified resident was unavailable.
Reporting Surgical Assistance in Total Hip Replacement Surgery
Let’s assume a 54-year-old woman suffers from severe hip pain and inflammation due to osteoarthritis. The only solution? Hip replacement surgery! She is admitted to a teaching hospital for the procedure. The complexity of her case requires surgical assistance.
However, her operating surgeon involves an attending surgeon in the procedure due to the lack of a qualified resident. He then bills the procedure using CPT code 27130, applying modifier 82 to communicate this information.
Reporting Assistant Surgeon’s Involvement in a Cholecystectomy
Suppose a 43-year-old woman with painful gallstones is scheduled for a laparoscopic cholecystectomy (gallbladder removal surgery) in a teaching hospital. The general surgeon, let’s assume Dr. John, is authorized to perform the procedure with the assistance of one or more residents.
However, due to the unavailability of a qualified resident, Dr. John is assisted by an attending gastroenterology surgeon. The billing specialists then report this procedure (CPT code 47563) with modifier 82 to claim payment for the primary and assistant surgeons.
Accurate Usage Guidelines for Modifier 82
With the description and examples above, you should now understand that you cannot use modifier 82 for all types of surgical assistance. But did you know there are additional rules for using this modifier? Let’s explore its accurate and inaccurate uses.
Accurate Usage of Modifier 82
Using this modifier is only appropriate under the following conditions:
- The procedure is performed in a teaching hospital.
- An assistant surgeon is involved due to the unavailability of a qualified resident surgeon (This unavailability is the primary prerequisite for using this code).
- The procedure is surgical (You can only apply modifier 82 to surgical CPT codes).
- If you can justify the medical necessity of an assistant’s role for services marked with Assistant Surgeon Indicator 0 in the Medicare Physician Fee Schedule Database (MPFSDB).
Inaccurate Usage of Modifier 82
You cannot use this modifier in the following cases:
- The operative report does not explain the unavailability of a resident surgeon.
- A non-surgeon assistant was involved in the procedure instead of a physician (MD/DO).
- The surgical procedure was performed outside of a teaching hospital.
- The procedure was non-surgical.
- The procedure has an Assistant at Surgery Indicator of 1 or 9 in the MPFSDB.
Documentation Requirements for Modifier 82
As mentioned before, your documentation must explain why the resident surgeon was unavailable. Therefore, include the following details in the operative report:
- A statement explaining the unavailability of a qualified resident.
- Assistant surgeon’s role in the procedure.
- Exceptional circumstances (if any) leading to the involvement of an assistant surgeon.
In short, these details will help you avoid claim denials when using this modifier. Just keep one more thing in mind. Some primary surgeons have a no-resident policy, meaning they never involve residents in preoperative, operative, or postoperative care. If this applies, mention it in the supporting documentation when submitting claims with modifier 82.
Comply with Payer-Specific Requirements
Insurance companies have varying requirements for modifier 82. For example, Medicare uses Assistant Surgeon Indicators to determine reimbursement eligibility. Therefore, go to the CMS website and check the Physician Fee Schedule to verify these values for the performed procedure.
- If the indicator is 0, Medicare will only pay for the surgical assistance if it is medically necessary. Therefore, attach the supporting documentation.
- If the indicator is 1, do not append modifier 82 to the surgical code, as Medicare may not pay the assistant surgeon.
- If the indicator is 2, you can apply this modifier without any worry.
- If the indicator is 9, it means the procedure is non-surgical, and you cannot use this modifier.
Most commercial payers follow similar guidelines for this modifier as Medicare. However, some may have different requirements. Therefore, check their websites or billing manuals for specific usage guidelines. You can also contact them directly if you need further clarification.
Summary
There you have it — a simple yet thorough explanation of modifier 82! To summarize, this code communicates that the primary surgeon received help from an assistant surgeon only due to the unavailability of a qualified resident surgeon.
From description to real-world examples, we have covered this modifier quite comprehensively so you can understand it better. Moreover, we have also provided additional rules for using this code accurately. In short, append this modifier to only surgical CPT codes to avoid claim denials.
