Ophthalmology and Optometry Coding Alert

Question: The ophthalmologist 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.

You'll find HGSA's policy online at www.hgsa.com/professionals/refman/chapter22.shtml. Advice for You Be the Coder and Reader Questions provided by Maggie M. Mac, CMM, CPC, CMSCS, consulting manager for Pershing, Yoakley & Associates, Clearwater, Fla; and Raequell Duran, president of Practice Solutions, Santa Barbara, Calif.