Pulmonology Coding Alert

Question: How do I find out if I can bill a procedure with an assistant surgeon? Washington, D.C. Subscriber Answer: Look at column AA of the 2008 Medicare Physician Fee Schedule (which you can find at http://www.cms.hhs.gov/PhysicianFeeSched/PFSNPAF/list.asp?listpage=3). A "2" in the column means the surgery allows payment for an assistant. A "0" means you might get paid, but you'll have to submit documentation showing the medical necessity for the assistant. A "1" is a no-go, indicating "assistant at surgery may not be paid," according to Medicare. Remember: The main thoracic surgeon reports the CPT code without a modifier and should identify the assistant's presence and the work he performed within the op note instead of submitting a second op report. The assistant reports his work and bills for his services by adding an assistant surgeon modifier to the procedure code(s) performed. Modifiers that may apply include: Modifier 80 -- Assistant surgeon for an MD or DO assisted on the majority of the case (Medicare pays at 16 percent) Modifier 81 -- Minimum assistant surgeon for an MD or DO assisted on less than the majority of the case Modifier 82 -- Assistant surgeon (when qualified resident surgeon not available) in an academic institution for a physician assistant (PA), nurse practitioner (NP) or clinical nurse specialist (CNS) when no qualified resident is available Modifier AS -- Medicare modifier for a PA, NP or CNS who is an assistant at surgery (Medicare pays at 13.6 percent).