Modifiers are always easy to understand but difficult to apply. Yes, while reading the description of modifiers it will be clear for medical coders when to use the these modifiers, but while coding medical charts it become difficult for them to choose the correct modifier. We have already gone through modifiers like 59 or X{EPSU}, 58, 78, 79, 25, 27, 26, TC etc. Each modifier is different from other, but still they create a lot of confusion among coders while using them.

For example, coders have a lot of trouble is using modifier 26 and TC modifier. Similarly modifier 62 vs 80, which have close difference among them, is also a very big headache for coders. Co-surgeons and assistant surgeon should be distinguished for coding modifier 62 and 80 respectively.

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Modifier 62 vs 80

To understand the best use of correct modifier, we have to first look at their description.

MODIFIER 62 – CO-SURGEONS

In some scenarios, individual surgeons with individual skills have to work as a team to perform a surgery on the same patient during the same operative session. These are rare complex procedures, which have to perform by two surgeons. In these cases, the additional physician is not acting as an assistant-at surgery.

In these scenarios, a surgeon and a co-surgeon of different specialties perform a co-surgery( a single surgical procedure) simultaneously (e.g.heart transplant or endovascular aortic aneurysm repair).

Co-surgery has been performed if the procedure(s) performed is (are) part of and would be billed under the same surgical code [e.g., placement of an aortic aneurysm stent graft (CPT code 34803) by a vascular surgeon and an interventional radiologist]. In this case, each physician reports code 34803 with the -62 modifier (two surgeons). Payment for each surgeon is 62.5% of the Medicare fee schedule amount.

Procedures that a -62 modifier may be appended to are identified in the Physician RVU file under the column titled “CO-SURG“, with the following indicators:

0 = Co-surgeons not permitted for this procedure.

1 = Co-surgeons could be paid, though supporting documentation is required to establish the medical necessity of two surgeons for the procedure.

2 = Co-surgeons permitted and no documentation required if the two-specialty requirement is met.

9 = Concept does not apply.

When to use Modifier 80:Assistant Surgeon

For modifier 80, the Medicare follows some rules for payment of reports with assistant surgeon.

The person reporting the service is a physician and provides full assistance to the primary surgeon or bears the designation of physician assistant (PA), nurse practitioner (NP), nurse midwife (NM), or clinical nurse specialist (CNS).

Medicare reimbursement is not allowed for surgical technician, first surgical assistant, scrub nurse, or bears any title other than those listed, acting as assistant surgeon.

Procedures that are covered for assistant-at-surgery are identified in the Physician RVU file under the column titled “ASST SURG”, with the following indicators:

0 = Payment restriction for assistants-at-surgery applies 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.

9 = Concept does not apply.

When paid, the payment for a physician assistant is 16% of the physician fee schedule. Payment for a NP, NM, or CNS assistant is 85% of the 16% of the physician fee schedule (13.6%).

How to find Eligibility (CPT code example) for 62 and 80 Modifier

Just visit the below links of CMS Physician Fee Schedule look up tool

http://www.cms.gov/apps/physician-fee-schedule/search/search-criteria.aspx

Now enter the CPT code eg. 43246 in the HCPCS code box and keep other information same as shown below. Click the Search Fees box to get results.

Now below are the search results. Since their are many columns in the results you have to slide the results to come to the Co-surgeon column as shown below. As shown in the highlighted section, 62 modifier has 2 Co-surgery indicator. This indicator shows the “Co-surgeons permitted; no additional documentation required with the initial claim to establish medical necessity“.

This is how you can find co-surgery indicator for all surgical procedures. You can also find the reimbursement rate, cost, price of a particular CPT code with or without 62 modifier for different MAC region/locality in this place.

Also you can see the Assistant-at-surgery (Asst Surg) column has ‘0’ modifier indicator which say “Payment restriction for assistants-at-surgery applies to this procedure unless supporting documentation is submitted to establish medical necessity” hence CPT 43236 is not eligible for assistant at surgery modifier 80.

Now if we search for CPT code 12018 we get the below results with ‘2′ as modifier indicator for assistant at surgery. Which means “Payment restriction for assistants-at-surgery does not apply to this procedure. Assistant-at-surgery may be paid” hence this CPT code is eligible for assistant at surgery modifier 80, while Co-surgeon is not eligible with ‘0‘modifier indicator.