Distinguishing Modifiers -80, -81, -82 and -AS

Surgeons often use assistants in the operating room, but with three CPT modifiers (-80, -81 and -82) and a HCPCS modifiers (-AS) to describe assisted surgery, coding for such services can be confusing. By reviewing CPT, CMS and payer guidelines, you can minimize the confusion.

Although modifiers -80 (Assistant surgeon), -81 (Minimum assistant surgeon) and -82 (Assistant surgeon [when qualified resident surgeon not available]) all define an assistant at surgery, each has a distinct purpose.

Modifier -80 is the most commonly used of the three and describes the presence of a second physician in the operating room who acts as an extra pair of hands"" to assist the primary surgeon. A common example of this is when a general surgeon and neurosurgeon work together during placement of spinal instrumentation (for example 22842 Posterior segmental instrumentation [e.g. pedicle fixation dual rods with multiple hooks and sublaminar wires]; 3 to 6 vertebral segments). Most payers reimburse an assistant surgeon (which in this case is the general surgeon) at 16 percent of the regular fee schedule amount (for instance about $126 for 22842 based on an average national payment of $785 for the primary surgeon: 785 x 0.16 = 125.6).

Do not confuse modifier -80 with modifier -62 (Two surgeons) which describes two physicians acting as cosurgeons. Section 15044 of the Medicare Carriers Manual specifies that each cosurgeon serve as the primary surgeon during some part of the operation and that each perform a distinct portion of a single reportable procedure(if each surgeon performs a separately reportable procedure even during the same operative session they are not cosurgeons). Although the surgeons operate on the same patient during the same operative session they in fact work independently of one another. Note that a single surgeon can serve as cosurgeon and assistant surgeon during different portions of the same operative session.

As an example a trauma patient with two shattered thoracic vertebrae undergoes surgery for spinal reconstruction resulting in the following procedures: