Outpatient Facility Coding Alert

Published on Tue Aug 26, 2014 PDF

Question: The physician does Austin bunionectomy and treats a hallux valgus by surgically treating the MTP joint of the great toe by performing a Chevron osteotomy. He uses a surgical assistant during this procedure. Does the assistant get paid by the insurer?

California Subscriber

Answer: The first step is to check with your insurers. For instance, if you review the Medicare Physician Fee Schedule, you’ll see that Medicare assigns the “2” indicator to this code in the “ASST SURG” column, which means that “Payment restriction for assistants at surgery does not apply to this procedure. Assistant at surgery may be paid,” Medicare says. Therefore, you should bill for a surgical assistant during these procedures if the documentation demonstrates medical necessity for the assist. If the payer accepts the assistant surgeon’s charge, you’ll append modifier 80 for the assistant’s services.

Caveat: If a nonphysician practitioner (NPP) serves as an assistant surgeon, you must use modifier AS (Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery) to Medicare payers to represent the assistant’s work.