Billing with modifier 80

Cindy1955

Guest
Messages
4
Location
Fairbanks, AK
Best answers
0
Hi i would like some input on billing with modifier 80, I have taken several coding courses and attended many coding seminars and been told that as a tip i should bill the primary surgeons fee with modifier 80 and let each payer make the adjustment instead of me adjusting the primary surgeon fee because each payer may have a different % of what they allow. Would appreciate any input on this question.
You can email me at cindylamoureux@gmail.com.
Thank You

So far I have received no replies on my question can someone please help.
Thanks
 
Last edited:
Messages
811
Best answers
0
Modifier 80 is attached to the assistant surgeon's charge. Assuming the procedure code allows for an 80 mod, you would bill CPT 12345 for the primary surgeon and 12345-80 for the assistant on separate claims with the normal billed amount. The appropriate documentation is needed by both the primary and the assistant (separate notes) indicating the work done by each, cross referencing to each other's op note. The payer may review the documentation to determine payment or they may just pay the normal adjusted amount for mod 80, which, last I knew, was 16% of the fee schedule amount.

Basically you bill the assistant (not the primary) surgeon's claim with the 80 mod at the normal price for the procedure and the payer will use the 80 pricing modifier to make the adjustment to the reimbursement.
 

CodingKing

True Blue
Messages
3,955
Best answers
1
In general if the modifier discounts the procedure do not do the discounting on your side.
 

espressoguy

Guest
Messages
406
Location
Tacoma, WA
Best answers
0
To bill for an assistant surgeon with mod 80, there is no requirement for separate documentation by the assistant. The assistant does need to be listed as an assistant in the primary surgeon's documentation.

If the second surgeon is, in fact, a co-surgeon, then they do need to dictate their own note and both surgeons would use modifier 62.
 
Messages
811
Best answers
0
In the facility I work at, every assistant surgeon has their own documentation. We've never had a payer, including Medicare, accept the primary surgeon's op report in order to pay for the assistant's charges as they go out on a separate claim. I'm trying to figure out in what scnerio an assistant surgeon wouldn't separately document the work they did. Without documentation, they have nothing to attest to and sign off on. Can you give me an example?

"The surgeon should specify in the body of the operative report what the assistant actually did. It’s insufficient to simply list the assistant’s name. The surgeon should clearly explain in the “indications” paragraph of the note why an assistant was necessary, and that he or she was involved in the actual performance of the covered surgical procedure, and not simply there to perform other ancillary services."
https://www.aapc.com/blog/25432-prompt-proper-assistant-at-surgery-payment/
 
Top