Oncology & Hematology Coding Alert

Question: The oncologist I code for sometimes performs surgery at a teaching hospital. Would you explain when I should append modifiers 80 and 82?

Pennsylvania Subscriber Answer: In the teaching hospital setting, you may report any of these modifiers when your documentation supports it. Snag: Your payer may decide that these modifiers don't earn you extra money in a teaching hospital.
 
When a surgeon opts not to use an available resident as an assistant during surgery, append 80 (Assistant surgeon) to your claim. Don't expect Medicare carriers, such as Pennsylvania's HGSA, to pay extra for this modifier when you're in a teaching hospital. Exception: If the primary surgeon has a policy never to involve residents in any stage of a patient's operative care or you can prove an exceptional medical circumstance, such as a life-threatening situation, Medicare may pay.
 
The descriptor for 82 (Assistant surgeon [when qualified resident surgeon not available]) tells you to use this modifier when no qualified resident surgeon was at hand for the surgery. Don't miss: Also use this modifier for surgeries requiring an assistant performed in a teaching hospital without an approved training program in the surgery's medical specialty.
 
You'll find HGSA's policy online at www.hgsa.com/professionals/refman/
chapter22.shtml.
 
Caution: Individual states decide whether an advanced nurse practitioner may serve as an assistant at surgery. When an ANP or physician assistant is serving as assistant at surgery, for Medicare, you'll usually use modifier AS (Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery). Private payers may prefer a different modifier. Remember: Some payers may not cover a PA or ANP as an assistant at surgery or may have their own rules for credentialing the nonphysician practitioners separately.

 - The answers for You Be the Coder and Reader Questions were reviewed by Cindy C. Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc. in Powder Springs, Ga., and president, AAPC National Advisory Board.