Neurosurgery Coding Alert

Medicare prohibits NPPs from using modifier 80 Faced with the choice of three CPT modifiers, plus a HCPCS modifier -- all with similar definitions -- even an experienced coder can easily become overwhelmed when trying to report an assistant-at-surgery claim. Our experts offer five steps to reduce the confusion and append the correct modifier, every time. 1. Check Eligibility As a first step, you must determine if the code for which you wish to report an assistant at surgery is eligible for assistant-at-surgery payment, says Suzan Berman-Hvizdash, CPC, CPC-E/M, CPC-EDS, physician educator for the University of Pittsburgh and past member of the American Academy of Professional Coders National Advisory Board. Payers will not reimburse for assistants at surgery in all cases, regardless of the modifiers you append to the claim. "Many carriers create their own rules that determine which practitioners can bill as assistant surgeons," says Barbara J. Cobuzzi, MBA, CPC-OTO, CPC-H, CPC-P, CPC-I, CHCC, consulting director of education for The Coding Institute in Naples, Fla. For Medicare, services rendered by an assistant at surgery are eligible for reimbursement only when national claims data indicate the procedure necessitated an assistant in at least 5 percent of the claims based on a national average, according to the Internet Only Manual, Chapter 20, Section 20.4.3. The easiest way to check if a code is eligible for assistant-at-surgery payment is to check the "ASST SURG" column of the Medicare Physician Fee Schedule Relative Value File, Cobuzzi says. If you find a "2" in this column for the code you wish to report, Medicare will reimburse for an assistant at surgery. Likewise, if you find a "0," Medicare will allow payment for an assistant at surgery as long as you submit supporting documentation to establish medical necessity. In contrast, a "1" in the "ASST SURG" column tells you that Medicare will never pay for an assistant at surgery, while a "9" indicates that the concept of assisted surgery does not apply. Resource: You can download the Physician Fee Schedule Relative Value File from the Medicare Web site, www.cms.hhs.gov. From the home page, search for "PFS Relative Value File," and select the first search result. Be sure to download the most recent (2008) file available. What Is an -Assistant at Surgery-? According to Medicare guidelines set forth in the Internet Only Manual (chapter 20, section 20.4.3), "an assistant at surgery must actively assist when a physician performs a Medicare-covered surgical procedure. This necessarily entails that the assistant be involved in the actual performance of the procedure, not simply in other, ancillary services." The IOM continues, "Since an assistant would, thus, be occupied during the surgical procedure, the assistant would not be available to perform (and [...]