Wiki Help! use of modifiers 80, 81 & 82 in a teaching hospital

[cmedeiros]

So here's the scenario, hopefully one of you can help :

Physician A has 4 surgeries scheduled when the night before she injures her wrist and can no longer perform those surgeries. She calls physician B, her colleague who works in the same hospital and specialty to perform those surgeries for her, as the primary surgeon.

However, Physician A performs a small portion of the surgery (CPT code 38792), while Physician B performs the major portions (CPT codes 19303-50 and 38525-50).

Would it be appropriate to bill for the services indicating Physician A as the assistant and append modifier 80 to CPT 38792? According to Medicare guidelines, in a teaching hospital (which my hospital is considered) an assistant surgeon is only appropriate when there is no qualifiying resident available to perform the surgery. I don't know that this was the case in this scenario.

http://www.ngsmedicare.com/content.aspx?CatID=2&DOCID=2183

Also, if I were to bill Physician A as having performed 38792 with modifier 80, would I do the same for Physician B since she is the primary surgeon in this case?

How do I bill for these services?
Please help!!

 

[FTessaBartels]

Teaching hospital

Modifier 82 is required for use in teaching hospitals to identify the assistant surgeon when no qualified resident was available.

Only the primary surgeon dictates an operative report. The primary surgeon is responsible for naming the assistant surgeon(s) and specifically stating the role that surgeon took in the procedure.

The assistant surgeon does not have to dictate at all.

In a teaching hospital, the primary surgeon is also responsible for stating in the operative report whether there was no qualified resident available. Absent this statement you cannot code for an assist from another surgeon.

If you happened to have a resident in the room also, you will probably not be able to code for Dr A's services at all.

You will need to check the edits for these procedures to see if an assist is even allowed.

I do not know how your operative report reads, or what the edits say, but can you code the 38792 for Dr A and the 19303 and 38525 for Dr B? (You would need two distinct operative reports.)

Hope that helps.

F Tessa Bartels, CPC, CEMC

 

[cmedeiros]

Thanks so much for your response...now, what if the 2 physicians are in the same group? Or in the same specialty but different groups?

 

[FTessaBartels]

Same rule

We are in a teaching hospital. We have had the occasional (and certainly not usual) case of two surgeons from the exact same practice/specialty serve as assist to each other. It usually requires an appeal and submission of operative notes, but we are successful.

NOTE - we are a pediatric center - no Medicare. (But we DO have Medicaid patients.)

F Tessa Bartels, CPC, CEMC