Wiki Assistant Surgeon (80, 81)

[BS&SC]

I am typing this in a hurry, so I hope my question reads clearly. I am new to surgical coding and my providers have communicated that they always have another provider standing by when they do deliveries (OB/GYN) but they don't document in their op note if that person is called in to help what that person does. I have tried to rectify this and a couple have added addendums showing the necessity (patient was hypotensive and hemorrhaging). Today I got one that wanted the 80 mod because, "The 5mm port site 3cm above the ASIS and 8cm from the midline on the right side was placed by assistant Dr.____. The left fallopian tube was grasped with the Maryland grasper by Dr. ___ to assist in elevating the tube while I used the harmonic scalpel to make successive cauterizations and cutting to excise the left fallopian tube. The right fallopian tube was excised with the Harmonic scalpel by Dr. ____ while I elevated it with the Maryland graspers."

I did not feel this showed urgency or medical necessity for the presence of an assistant. And, at most, only for the use of the partial assist modifier, though I don't think I have seen any OB/GYN codes that allow for the use of that mod. So, am I wrong that the documentation is lacking medical necessity for an assistant? Does anyone have a good educational site showing proper examples of documentation for the 80 modifier.

Also, my understanding is that the 80 modifier allows for 16% of the total of the procedure cost. Is this correct or is it 16% in addition to the cost of the procedure?

Thanks in advance!

 

[patti66]

The way we handle the assistant surgeons at my hospital is as long as the other MD is listed in note and what they did (which seems like they did here) we append 80 mod to main procedure(s) billed. But always check the CMS physician fee schedule Overview of the Medicare Physician Fee Schedule Search | CMS to make sure the codes allow assist

 

[csperoni]

For deliveries, typically the primary obgyn is billing for global maternity. If the physician on standby actually assists in the delivery, the op note of the primary obgyn should indicate who that was and what they did. The assistant obgyn would then bill the DELIVERY ONLY (never global maternity) codes with -80 or -81 (depending on what is appropriate in your situation).
For example - vaginal delivery
Primary ob likely billing 59400
Assistant ob bills 59409-80 or -81.
C-section:
Primary ob bills 59510
Assistant ob bills 59514-80 or -81
With a patient requiring a salpingectomy, I certainly would not question the medical necessity of another surgeon, and you would have an additional code besides the delivery (if the second doc even assisted in the delivery).

Most insurances reimburse the assistant at 16% of the fee schedule for the CPT(s) billed.

Please note: Deliveries are the only codes I am aware of where the assistant bills different codes than the primary.
I hope this helps explain the unique situation for delivery assists.

 

[BS&SC]

If billing 59409 for the assist, or even for a salpingectomy following a C-section, wouldn't that be the reason to use an 81 versus an 80–because they were not there for the entirety of the main procedure. Wouldn't that, in itself, be a solid reason to assign an 81?

Another example: A doctor had an assistant come in to control a hemorrhage following a c-section. To me that is an 81 versus an 80. Am I thinking right?

 

[csperoni]

The assist being present for only a short portion of the procedure would be a good example of -81 vs -80.
In your original post with the example of the salpingectomy, it appears the assist even did a portion of right side as primary. I would not use -81 in that scenario.