Modifier 81 describes the minimum assistant surgeon and indicates that an assistant surgeon assisted the principal surgeon during part of a procedure.
1. What is modifier 81?
Modifier 81 indicates that an assistant surgeon assisted the principal surgeon during part of a procedure. The assistant surgeon performs under the direct supervision of the principal surgeon and is often in the same specialty as the principal surgeon.
2. When to use modifier 81?
Modifier 81 should be used when an assistant surgeon assists the principal surgeon during part of a procedure. For example, the principal surgeon oversees the patient’s case, and the assistant surgeon may be necessary because the procedure or the patient’s condition is complex.
The official description of modifier 81 is “minimum assistant surgeon.”
Examples of procedures that may require modifier 81 include complex surgeries such as heart bypass surgery, spinal fusion, and joint replacement.
To use modifier 81, the medical record must document the assistant surgeon’s participation in the procedure, including the specific tasks performed. The documentation should also include the assistant surgeon’s qualifications and credentials.
To bill for an assistant surgeon’s services with modifier 81, the principal surgeon submits the procedure code for the surgery to the payer. The assistant surgeon submits the same procedure code with modifier 81.
Medicare and many other payers require providers to obtain preauthorization for services and procedures before approving assistant surgeons’ claims for payment.
7. Common mistakes
One common mistake medical coders make when using modifier 81 is failing to obtain preauthorization for assistant surgeon services.
Another mistake is using modifier 81 for procedures that do not meet the criteria for assistant surgeon services. To avoid these mistakes, medical coders should carefully review the documentation and guidelines for using modifier 81.
8. Other modifiers related to modifier 81
The other modifiers related to assistant surgeons include modifier 80, which indicates that the assistant surgeon assisted the principal surgeon during the entire procedure, and modifier 82, which indicates that the assistant surgeon assisted the principal surgeon during the entire procedure when a medical resident is not available to assist.