Wiki Use of “we” for modifier 80

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I have a provider who has done many, many surgeries with an assistant. The Op note I received last week regarding the use of an assistant said it is “standard procedure on a pelviscopy with bilateral salpingectomy.” In documentation, this same provider uses “we” to describe what the assistant surgeon did. As an ex: “we” ligated the mesosalpinx. “We” did the same on the left side.

From all of my research, the primary surgeon should document the actions the assistant makes, as well as establish the medical necessity for the 80 modifier. I have emphasized this many times in the past with this provider and this latest documentation seems to be the provider’s solution to both. I have had feedback not to question the need for an assistant, but from an auditing perspective, I worry that this documentation is not going to be enough to establish medical necessity, let alone show the assistant's actions autonomous of the primary surgeon’s. Thoughts?
 
I assume you are talking about non-teaching facilities.

The provider needs to document exactly what the assistant performs. The provider has to explain what the assistant did and justify it.
Examples from a MAC: https://www.novitas-solutions.com/webcenter/portal/MedicareJL/pagebyid?contentId=00144529

Assistant at Surgery Modifiers​

An assistant at surgery is a physician who actively assists the physician in charge of a case in performing a surgical procedure.
An "assistant at surgery" is a physician who actively assists the physician in charge of a case in performing a surgical procedure. The "assistant at surgery" provides more than just ancillary services. The operative note should clearly document the assistant surgeon's role during the operative session.

WPS MAC: https://www.wpsgha.com/wps/portal/m...ImccsXDVGk3WjpypX-jqfS_aaYvs6-5ubsA1g6nZg!!/#

This is usually the operative report to show:
  • the role of the assistant during the procedure
  • the medical reason the patient required an assistant at surgery

AAPC: https://www.aapc.com/blog/23393-assistant-at-surgery/
To bill for an assistant at surgery, the surgeon is required to specify in the body of the operative report what the assistant actually does. It is not sufficient evidence of participation to list the assistant’s name in the heading of the operative report. It is also a good idea to mention in the indications paragraph why there is a need for an assistant. Carriers that request the op report in order to process the assistant’s claim will deny claims if there is no accounting by the surgeon for what was performed by the assistant.

AAPC: https://www.aapc.com/blog/25432-prompt-proper-assistant-at-surgery-payment/
Not All Surgeries Merit Assistance
  1. Has the surgeon sufficiently documented the need for and role of the surgical assistant?
Just because a surgeon recruits an extra pair of hands to help during a surgical procedure doesn’t mean the payer will reimburse the assistant’s efforts. Surgical assistance must be deemed medically necessary (per the payer’s standards) to warrant additional payment.
 
amyjph said:
I assume you are talking about non-teaching facilities.

The provider needs to document exactly what the assistant performs. The provider has to explain what the assistant did and justify it.
Examples from a MAC: https://www.novitas-solutions.com/webcenter/portal/MedicareJL/pagebyid?contentId=00144529

Assistant at Surgery Modifiers​

An assistant at surgery is a physician who actively assists the physician in charge of a case in performing a surgical procedure.
An "assistant at surgery" is a physician who actively assists the physician in charge of a case in performing a surgical procedure. The "assistant at surgery" provides more than just ancillary services. The operative note should clearly document the assistant surgeon's role during the operative session.

WPS MAC: https://www.wpsgha.com/wps/portal/m...ImccsXDVGk3WjpypX-jqfS_aaYvs6-5ubsA1g6nZg!!/#

This is usually the operative report to show:
  • the role of the assistant during the procedure
  • the medical reason the patient required an assistant at surgery

AAPC: https://www.aapc.com/blog/23393-assistant-at-surgery/
To bill for an assistant at surgery, the surgeon is required to specify in the body of the operative report what the assistant actually does. It is not sufficient evidence of participation to list the assistant’s name in the heading of the operative report. It is also a good idea to mention in the indications paragraph why there is a need for an assistant. Carriers that request the op report in order to process the assistant’s claim will deny claims if there is no accounting by the surgeon for what was performed by the assistant.

AAPC: https://www.aapc.com/blog/25432-prompt-proper-assistant-at-surgery-payment/
Not All Surgeries Merit Assistance
  1. Has the surgeon sufficiently documented the need for and role of the surgical assistant?
Just because a surgeon recruits an extra pair of hands to help during a surgical procedure doesn’t mean the payer will reimburse the assistant’s efforts. Surgical assistance must be deemed medically necessary (per the payer’s standards) to warrant additional payment.
Click to expand...
Hello,
I have a follow up question on your response above.
I am a newbie to the teaching facility procedures, and you had mentioned, "I assume you are talking about non-teaching facilities "- Are the guidelines different for teaching hospitals?

I am currently debating on the documentation.
We had 2 surgeons, from the same group, both are attending physicians of a teaching hospital performing a major surgery. It was a very complicated procedure. And the OP notes by the primary surgeon included the term "we performed" for almost each step performed.

Can I code/bill all the procedures for BOTH the primary surgeon and the assistant surgeon with modifier 80 here?

Is there any other specific documentation requirement needed for the same or can I bill as is? If you have any reference articles, can you please share it here?

TIA
 
vidraj said:
Hello,
I have a follow up question on your response above.
I am a newbie to the teaching facility procedures, and you had mentioned, "I assume you are talking about non-teaching facilities "- Are the guidelines different for teaching hospitals?

I am currently debating on the documentation.
We had 2 surgeons, from the same group, both are attending physicians of a teaching hospital performing a major surgery. It was a very complicated procedure. And the OP notes by the primary surgeon included the term "we performed" for almost each step performed.

Can I code/bill all the procedures for BOTH the primary surgeon and the assistant surgeon with modifier 80 here?

Is there any other specific documentation requirement needed for the same or can I bill as is? If you have any reference articles, can you please share it here?

TIA
Click to expand...
See here:
100.1.7 - Assistants at Surgery in Teaching Hospitals (Rev. 811, Issued: 01-13-06, Effective: 01-01-06, Implementation: 02-13-06)
100.1.8 - Physician Billing in the Teaching Setting
100.2 - Interns and Residents

Commercial payers may have different rules.
 
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