How to Distinguish Assistant at SurgeryModifiers
Published on Tue Oct 01, 2002
Neurosurgeons often employ surgical assistants in the operating room, but with three CPT modifiers (-80, Assistant surgeon; -81, Minimum assistant surgeon; and -82, Assistant surgeon [when qualified resident surgeon not available]) and a HCPCS modifier (-AS, Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery) to describe assisted surgery, coding for such services can be puzzling. A review of CPT, CMS and payer guidelines can minimize the confusion. What's What? Although modifiers -80, -81 and -82 all define an assistant at surgery, each is distinct. Modifier -80, the most commonly used of the three, describes the presence of a second physician in the operating room who acts as an extra pair of hands to assist the primary surgeon. A common example is when an orthopedic surgeon and a neurosurgeon work together during placement of spinal instrumentation (e.g., 22842, Posterior segmental instrumentation [e.g., pedicle fixation, dual rods with multiple hooks and sublaminar wires]; 3 to 6 vertebral segments). Most payers reimburse assistant surgeons at 16 percent of the regular fee schedule amount, e.g., about $124 for 22842, based on an average payment of $776 for the primary surgeon. Do not confuse modifier -80 with modifier -62 (Two surgeons), which describes two physicians acting as co-surgeons. Section 15044 of the Medicare Carriers Manual specifies that each co-surgeon serves as the primary surgeon during some part of the operation and that each performs a distinct portion of a single reportable procedure. Although the surgeons operate on the same patient during the same operative session, they in fact work independently of one another. Note that a single surgeon can serve as co-surgeon and assistant surgeon during different portions of the same operative session. As an example, a trauma patient with two shattered thoracic vertebrae undergoes surgery for spinal reconstruction, resulting in the following procedures:
63087 Vertebral corpectomy (vertebral body resection), partial or complete, combined thoracolumbar approach with decompression of spinal cord, cauda equina or nerve root(s), lower thoracic or lumbar; single segment
+ 63088 each additional segment (list separately in addition to code for primary procedure)
22556 Arthrodesis, anterior interbody technique, including minimal diskectomy to prepare interspace (other than for decompression); thoracic [T9-T10]
+ 22585 each additional interspace (list separately in addition to code for primary procedure) [T10/T11 and T11/T12]
22846 Anterior instrumentation; 4 to 7 vertebral segments [T9-12]
In this case, two surgeons are required to complete the reconstruction. Surgeon A undertakes the vertebral resection, while B decompresses the spinal cord. Surgeon A performs the arthrodesis and, with surgeon B's assistance, places the instrumentation. Coding should appear as follows: Surgeon A
63087-62
63088-62
22556-51 (Multiple procedures)
22585 x 2
22846
Surgeon B
63087-62
63088-62
22846-80 Because each surgeon performs a distinct portion [...]
