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Thread: 35820 Assistant

  1. #1

    Default 35820 Assistant

    AAPC: Back to School
    How would you bill a 35820 (post-op bleed) for an assistant when modifier's 78, 80 and AS are mutually exclusive?

  2. #2
    Join Date
    Apr 2007


    I would do 35820-99-78-AS-80 if the assistant is a NPP, if the assistant was a doctor 35820-78-80.

    I don't have anything telling me I can't do this and my scrubber is saying it is correct based on CMS.

    Laura, CPC, CPMA, CEMC

  3. #3


    Per Medicare these are mutually exclusive modifiers per the denials we are receiving.

  4. #4


    CPT 35820 Exploration for postoperative hemorrhage, thrombosis or infection; chest

    Per CMS fee schedule the 35820 shows indicator "2" for Assistant Surgeon meaning an AS is allowed and paid

    Mod-AS is for an PA surgical assistant (or non-MD)

    Mod -80 is for an MD surgical assistant

    You will have to code the modifier based on what type of assistant. Using both -AS and -80 is why you are getting the mutually exclusive message
    Last edited by sbicknell; 06-03-2010 at 02:08 PM.

  5. #5
    Join Date
    Apr 2007



    Page 157. Per CMS guidelines both are required for PA assistant surgeons.

    We get paid using both, our carrier is WPS Medicare.

    Laura, CPC, CPMA, CEMC

  6. #6


    Pneely, I would verify with your medicare payer on their specific guidelines. Both Medicare payers I am familiar with state it is either -80 or -AS but not both. Also the WPS/Medicare link provided in an earlier post is from 2009

    Here is a link to WPS/Medicare Jan 2010 Guidance


    A paste of same..............'

    Assistant at Surgery Modifier Fact Sheet
    • 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.

    • Global surgery rules do not apply.
    • Reimbursement equals 16% of the amount otherwise applicable for the global surgery.
    Use the “80” modifier when the assistant at surgery service was provided by a medical doctor (MD).
    • Use the “82” modifier when the assistant at surgery service was provided by an MD and there was not a qualified resident available. Documentation must include information relating to the unavailability of a qualified resident in this situation.
    Use the modifier “AS” for assistant at surgery services provided by a Physician Assistant (PA) or Nurse Practitioner (NP). These claims must be submitted as assigned claims.

    Here is a paste from Texas Trailblazer/Medicare

    Assistant Surgeon
    Medicare will make payment for an assistant-at-surgery when the procedure is covered for an assistant and one of the following situations exists:
     The person reporting the service is a physician.
     The person bears the designation of a physician assistant, nurse practitioner, nurse midwife or clinical nurse specialist.

    80 Assistant surgeon
    81 Minimum assistant surgeon
    82 Assistant surgeon (when qualified resident surgeon not available)
    AS Physician Assistant (PA), Clinical Nurse Specialist (CNS) or Nurse Practitioner (NP) services for assistant-at-surgery

    The allowed amount for assistant-at-surgery services is 16 percent of the physician fee schedule. The allowable for the assistant-at-surgery services performed by an NP, PA or a CNS is 85 percent of the 16 percent allowed based on the physician fee schedule.

  7. #7


    I had this same scenario and WPS told us to remove the -78 from the assistant surgeon.

    In other words, I only needed to bill 35820-82 for the assistant (We use modifier -82 because we're a teaching hospital. If a PA assists, I use the -AS. I've never billed both the -82 and the -AS at the same time).

    Anyway, I don't have this in writing (I never looked for it in writing) but the claim was paid when I removed the -78 from the assistant's claim.

    Lisi, CPC

  8. #8


    yes, for the -78 issue.......

    Only the MD surgeon will code with the -78

    An MD assist will code with only -80 (or 81 or 82)

    A PA/NP assist will code with only -AS

    The -78 identifies the surgeon is doing a 2nd unplanned related surgery. It's irrelevant to identify this on the assistant regardless if a PA or MD.

  9. #9
    Join Date
    Apr 2007


    Just wanted to point out that the link I posted was not a WPS link, it is CMS and the most current one as of today. The carriers are supposed to at least adhere to CMS guidelines but can make them more stringent on their own, not less.

    Laura, CPC,CPMA, CEMC

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