Neurosurgery Coding Alert

Question: Can we bill for an assistant surgeon when reporting 61751?


Vermont Subscriber


Answer: Yes, you may bill for an assistant surgeon with 61751 (Stereotactic biopsy, aspiration or excision, including burr hole[s], for intracranial lesion; with computed tomography and/or magnetic resonance guidance), according to the Medicare Physician fee schedule database.

If you find 61751 in the fee schedule database, the "ASST SURG" column contains a "1" indicator. This means that you may append modifier -80 (Assistant surgeon) to the code to describe the presence of a second physician in the operating room who acts as an extra pair of hands to assist the primary surgeon.
 
In contrast, a "0" in the ASST SURG column means that modifier -80 is not allowed with that particular code, while a "2" means you may claim an assistant surgeon for the procedure, but only if each surgeon is of a different specialty. A "9" indicates that the concept of assistant surgeon does not apply.

Most payers reimburse assistant surgeons at 16 percent of the regular fee schedule amount. Using current (2005) figures, that means the primary surgeon would earn about $410 for the procedure, while the assistant surgeon would receive about $65.

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.

Tip: For more information on the 2005 Medicare fee schedule, see our news brief entitled, 2005 Physician Payments Rise.