Wiki assistant on c-section

[mlange85]

Hello! We bill 59514 with an 80 modifier for an assist on C-section. This has always been paid. However, we just started to receive take back requests for this. They mention it is due to the payment indicator. Can anyone offer any advise or help? Thank you!

 

[unicorn80]

I found four payment indicators under modifier 80. Which indicator did you use?

 

[Bready]

Payment indicator means "medical necessity" C-sections don't necessarily require an assistant surgeon so your op report would have to prove medical necessity and what portion the physician assisted in order to successfully appeal the take-backs and for future claims.