Assisting Surgeons Use Same Code as Primary Surgeons
Published on Fri Feb 01, 2002
About one of every four family physicians serves as an assistant at surgery, according to the American Academy of Family Physicians (AAFP) 2001 practice profile survey. To be reimbursed for the surgery, the physician's office must use the proper procedure code, append a modifier and, in some cases, document the medical reason an assistant was needed.
The assisting surgeon uses the same procedure code as the primary surgeon and appends modifier -80 (assistant surgeon) or uses the separate five-digit modifier 09980, says Kent Moore, manager of Health Care Financing and Delivery Systems for the AAFP. Modifier -80 applies when the assistant surgeon is present for all of, or a substantial portion of, an operation.
Two other modifiers apply less frequently:
09981 or -81 (minimum assistant surgeon) is used when the assistant provides minimal assistance to a surgeon for a relatively short time.
09982 or -82 (assistant surgeon [when qualified resident surgeon not available]) usually applies to teaching hospitals and is used when a qualified medical resident, who typically performs the assistant's role, is unavailable.
Assistants Usually Covered for C-Sections
Probably the most common procedure when the family physician assists is a Cesarean section, Moore says. He notes that the AAFP practice profile survey found that 22.3 percent of family physicians perform routine obstetrical deliveries in hospitals. When a C-section becomes necessary, the family physician may call in an ob/gyn because the family physician lacks surgical privileges or is not comfortable performing surgery, Moore says.
Carol Sissom, CPC, senior consultant at the Indianapolis-based Health Care Economics Inc., says the family physician often calls in an obstetrician when a fetus has complications, such as a breech first position as labor begins. Typically the ob/gyn performs the C-section, while the family physician assists, Sissom says.
In this scenario, the family physician's office uses 59514 (Cesarean delivery only) appended with modifier -80 and a diagnosis of 652.21 (breech presentation without mention of version; delivered, with or without mention of antepartum condition), Sissom says. Modifier -80 indicates that the assistant was actively involved in the surgery. Use modifier -81 only if the family physician plays a minimal role, such as applying a clamp if there is bleeding, Sissom says.
"If the assistant actually gets hands-on either opening the abdomen or helping remove the baby you would want to use modifier -80," Sissom says.
With many carriers, it isn't necessary to document a complication requiring an assistant's help at a C-section. Because Medicare includes C-sections for surgeries that don't require documentation that an assistant helped with a complication, many insurance companies will also cover an assistant for C-sections, says Mark Painter, vice president of reimbursement and coding information at Physician Reimbursement Systems in Denver.
However, some carriers may require [...]
