September 7, 2017
Question:
We are seeing payors ask for payment back when we use Modifier 80 for assistant surgeon. Is there a reason why they would take the payment back?
Answer:
We are seeing payors including Medicare and Medicaid ask for payment recovery when the documentation does not explain what role the assistant played in the surgery. It is not enough to state that the procedure was complex. Specifics of what the assistant did, assisted with the resection and anastomosis for example, must be documented to support billing for an assistant surgeon.
*This response is based on the best information available as of 09/07/17.
