Modifier 80 | Assistant Surgeon Explained

Modifier 80 indicates that an assistant surgeon was present during the entire procedure and performed under the direct supervision of the principal surgeon. This article will explore the definition, appropriate usage, documentation requirements, billing guidelines, common mistakes, and related modifiers for modifier 80.

1. What is modifier 80?

Modifier 80 describes the role of an assistant surgeon during a surgical procedure. It is used to indicate that the assistant surgeon was present during the entire procedure and performed under the direct supervision of the principal surgeon.

This modifier is necessary for accurate billing and reimbursement for the services provided by the assistant surgeon.

2. When to use modifier 80?

Modifier 80 should be used when an assistant surgeon is present during the entire surgical procedure and performs under the direct supervision of the principal surgeon.

The assistant surgeon must be in the same specialty as the principal surgeon and must be necessary due to the complexity of the procedure or the patient’s condition. The use of modifier 80 should be based on medical necessity and not used for routine procedures.

Only physicians can use the assistant surgeon modifiers for procedures, and other clinicians should not use them.

3. Description

The official description of modifier 80 is “assistant surgeon.”

4. Examples

Examples of procedures that may require modifier 80 include complex surgeries such as heart bypass surgery, brain surgery, and organ transplants.

In these cases, an assistant surgeon may be necessary to ensure the safety and success of the procedure.

5. Documentation

Documentation requirements for modifier 80 include a clear indication of the assistant surgeon’s role in the procedure and the medical necessity for their presence.

The documentation should also include the name and credentials of the assistant surgeon and the principal surgeon, as well as the date and location of the procedure.

Ensure that the documentation supports modifier 80 for accurate billing and reimbursement.

6. Billing

To bill for assistant surgeon services using modifier 80, the principal surgeon should submit the procedure code for the surgery to the payer. The assistant surgeon should submit the same procedure code with modifier 80.

Follow the payer’s guidelines for preauthorization and reimbursement for assistant surgeon services, as they may vary depending on the payer and the procedure.

7. Common mistakes

Medical coders make common mistakes when using modifier 80, including using it for routine procedures, failing to document the medical necessity for the assistant surgeon, and using it when other modifiers, such as modifier 62 or modifier 66, would be more appropriate.

To avoid these mistakes, carefully review the documentation and follow the guidelines for using modifier 80.

8. Other modifiers related to modifier 80

Other modifiers related to modifier 80 include modifier 81, used when the assistant surgeon assists the principal surgeon during part of the procedure, and modifier 82, used when a qualified resident surgeon is not available to assist.

Use the appropriate modifier based on the assistant surgeon’s role in the procedure and the medical necessity for their presence.