Friday, April 30, 2010

Assitant sugeon Modifier 80

Surgical - 80 Modifier

80    Assistant Surgeon: Surgical assistant services may be identified by adding the modifier 80 to the usual procedure number(s).

This modifier should be reported to identify surgical assistant services performed in a non-teaching setting or in a teaching setting when a resident was available but the surgeon opted not to use the resident. In the latter case, the service is generally not covered by Medicare. When the surgical services are performed in a non-teaching setting, report “Non-teaching” in the narrative section of an electronic claim submission, or in Block 24D for paper claims.

Reimbursement 80 – Assistant Surgeon MD’s = 20% of the full service physician fee on file. Certified Nurse Midwives = 80% of MD’s ‘Assistant Surgeon’ fee. AS – First Assistant in Surgery: Qualified Phys. Assistant, Nurse Practitioner, or Clinical Nurse Specialist 80% of MD’s ‘Assistant Surgeon’ fee AT – Acute Treatment Chiropractors use this modifier when reporting service 98940, 98941 Fee on file

Surgical Assistant Guidelines

Payment is made only if an assistant surgeon is allowed on the Federal Register.

Modifier 80—Assistant Surgeon (MD, DMD, DDS, DO)]

• The allowance for modifier 80 is 20 percent of the surgery Procedure  allowance.

Modifier 81—Minimum Assistant Surgeon (MD, DMD, DDS, DO)

• The allowance for modifier 81 is ten percent of the surgery Procedure  allowance.

• This modifier is used when the doctor performed minimal assistance.

Modifier AS—Non-physician Assistant (PA, RN, CRNFA, CST, CNM, SA)

• The allowance for modifier AS is ten percent of the surgery Procedure  allowance.

To ensure accurate payment, please make sure when you are billing assistant surgeon claims that you submit the full billed amount, rather than the pre-cut amount. Our system will not recognize that the claim has been pre-cut (adjusted to show the assistant surgeon payment percentage), and it will be cut again according to the assistant surgeon guidelines.




Assistant-at-Surgery

*Assists the physician in charge of surgical procedure

*Modifier 80 used when the assistant at surgery service provided by a medical doctor

*Allowable based on 16% of MPFS

*Modifier AS used when the assistant at surgery service provided by a non-physician practitioner

*Examples include Physician Assistant and Nurse Practitioner

*Allowable based on 85% of 16% of MPFS

*MPFS Indicators for services where assistant at surgery allowed:

*0 = Payment restrictions for assistants at surgery applies to this procedure unless supporting documentation

*2 = Assistant at Surgery may be paid



Category         Indicator        Indicator Description

0
Payment restrictions for assistants at surgery apply to this procedure unless supporting documentation is submitted to establish medical necessity.

1
Statutory payment restriction for assistants at surgery applies to this procedure. Assistant at surgery may not be paid.

2
Payment restriction for assistants at surgery does not apply to this procedure. Assistant at surgery may be paid.


common Billing Errors (Mod 80 & AS)

*Claims for physician billed with modifier “AS”

*Claims for non-physician practitioner billed with modifier “80)

*Billed inappropriately with codes that have an Assistant-at-Surgery indicator of “1” (Assist at surgery may not be paid)



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