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modifier 82

  1. #1
    Default modifier 82
    Medical Coding Books
    hey everyone,
    I was wondering if anyone can give me a heads up on how and when to use mod. 82? I code for surgeons and our hospital is a teaching facility. So, when we have 1 attending assisting another on a sx, what has to be documented in order to use that modifier?

    any suggestions would help.
    Malama pono,

    Sundae Yomes
    CPC, CPMA, CEMC, CGIC, CGSC, CCS-P

  2. #2
    Default
    in order to capture -82 the asst surgeon must produce an op report detailing what he/she did (the primary surgeon must also document what the asst surgeon did in his/her op report)....remember if the asst surgeon is not an MD there are other modifiers which qualify

    Quote Originally Posted by sundaey View Post
    hey everyone,
    I was wondering if anyone can give me a heads up on how and when to use mod. 82? I code for surgeons and our hospital is a teaching facility. So, when we have 1 attending assisting another on a sx, what has to be documented in order to use that modifier?

    any suggestions would help.
    Rachele Porter, AS, CPC, CPC-H, CEDC
    no weapons formed against me shall prosper

  3. #3
    Location
    ENGLEWOOD/DENVER
    Posts
    2,338
    Default
    CPT Modifier 82


    Description:
    Assistant surgeon (when qualified resident surgeon not available)

    Guidelines/Instructions:
    Submit CPT modifier 82 to identify services of Assistant surgeon (when qualified resident surgeon not available)

    The unavailability of a qualified resident surgeon is a prerequisite for submitting CPT modifier 82 with a surgical procedure code.
    This modifier may only be submitted with surgery codes.
    No additional documentation is required with the claim when CPT modifier 82 is submitted.
    Documentation must be maintained in the patient's medical record:
    A statement that no qualified resident was available to perform the service, or
    A statement indicating that exceptional medical circumstances exist, or
    A statement indicating the primary surgeon has an across the board policy of never involving residents in the preoperative, operative or postoperative care of his/her patients.

    To determine whether the services of an assistant surgeon may be submitted to Medicare with CPT modifier 82, refer to the Medicare Physician Fee Schedule database (MPFSDB).
    Access the database directly from the CMS Web site at http://www.cms.hhs.gov/PFSlookup/.
    Select Physician Fee Schedule Search from the left area of the Web page.
    Screen defaults to current year. Under Type of Information, select Payment Policy Indicators, then “next.”
    On the “select field options” screen, select “Next.”
    Enter the procedure code and select “All Modifiers”, then click “Submit.”
    Refer to the column heading “Asst Surg.”
    Indicator 0 = Payment restriction for assistants at surgery applies to this procedure. Supporting documentation describing the medical necessity for an assistant surgeon must be submitted with the claim.
    Indicator 1 = Statutory payment restriction for assistants at surgery applies to this procedure. Assistants at surgery will not be paid.
    Indicator 2 = Payment restriction for assistants at surgery does not apply to this procedure. Assistants at surgery may be paid.
    Indicator 9 = Concept does not apply (the most likely explanation is that the procedure is not a surgery).

    Reference:
    CMS Pub. 100-04, chapter 12, sections 20.4.3, 40.8.D, 100.1.7: teaching hospital requirements: http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf
    CMS Pub. 100-04, chapter 23, in the Addendum following section 90: http://www.cms.hhs.gov/manuals/downloads/clm104c23.pdf

  4. #4
    Location
    Milwaukee WI
    Posts
    4,466
    Default How to document
    In a teaching facility, the primary/lead surgeon's operative note must
    1) list the assistant surgeon as such
    2) state that there is no qualified resident available to assist in this procedure
    3) indicate the level of assistance provided by the other surgeon

    The assistant surgeon does not need to provide a separate operative note.

    In a teaching facility you use the -82 modifier (vs -80 modifier in non-teaching facility). And, like rachelporter said - you need a different modifier (AS) if the assistant is a PNP or PAC.

    However, if the two surgeons are of different sepcialities and are acting as co-surgeons (modifier -62), then each surgeon much dictate a separate operative note describing his/her involvement in the case, and listing the other surgeon as a co-surgeon. (So Dr Sundaey's note will show himself as the surgeon, and Dr Bartels as the co-surgeon. And Dr Bartels's note will have Dr Bartels as the surgeon, and Dr Sundaey as the co-surgeon.

    Hope this helps.

    F Tessa Bartles, CPC

  5. Default 82 mod help
    I work at a teaching Hospital for Gen Surgeons,
    we are experiencing different versions of the 82 mod. the word Certificate on file is throwing us off in the guidelines. We have many Dr. who use Assistant Surgeons and would like clearification to date.
    thank you.

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