Cardiology Coding Alert

Reader Questions:

Review Handy Modifier Advice

Question: I’m trying to figure out when to use modifiers 62, 66, 80, and AS. Can you please help me understand these modifiers?

Alabama Subscriber

Answer: Append modifier 62 (Two surgeons) when there are co-surgeons. The two surgeons cooperate to perform a surgery within the same body cavity and with a single goal, each of them applies their own expertise to achieve that single goal. At the same time, they assist and complement each other. To bill for co-surgery, both surgeons must bill using the same CPT® code(s) and append modifier 62. In other words, you should append modifier 62 when two surgeons work together to complete a procedure described by a single CPT® procedure code.

To bill a service as co-surgeons, each physician should document their own operative notes. When surgeons are acting as co-surgeons, it is implied that they are each performing a distinct part of the procedure which means they can’t share the same documentation.

Use modifier 66 (Surgical team) for team surgery. If more than two providers of different specialties perform work during the same surgery, often using complex surgical equipment, you’ve got yourself a team. Every physician should document what they did, and it should be an equal portion spread throughout the team surgery. This usually means three surgeons, but in trauma situations, there can be more. Providers must ensure that the CPT® code is modifier 66-approved. You should refer to the Medicare Physician Fee Schedule Database (MPFSDB) to determine if CPT® modifier 66 is applicable to a particular surgical CPT® code. Note that team surgeries are normally limited to organ transplants and re-transplants.

Append modifier 80 (Assistant surgeon) when the primary surgeon uses an assistant surgeon. The primary surgeon may use an assistant surgeon for several reasons, such as when the procedure or the patient’s condition is more complex than the norm. The assistant surgeon works under the direct supervision of the principal surgeon and is often in the same specialty as the principal surgeon. The primary surgeon documents the name of the person and that they were the assistant. The assistant doesn’t have to document.

When an advanced practice provider (APP), such as a physician assistant or nurse practitioner, assists at surgery, attach modifier AS (Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery) to the surgical code. The APP does not have to document anything. The primary surgeon documents that the APP was the assistant.

Don’t miss: When talking about surgical assistants, it’s important not only to name them and their credentials but also why you needed them. More and more payers are looking at medical necessity on the surgical assistants.

Most payers will not pay for more than one assistant or co-surgeon. So, if you’ve got co-surgeons who are working on a heart procedure, and you have your APP who is harvesting the saphenous vein, for example, that is not billable in that situation mostly because the payer won’t accept the work done by a third person