April 13, 2017
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?
We are seeing many 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 document the surgeon’s name at the top of the operative note or to document that the surgery was complex. Actual detail of what the assistant did during the surgery (assisted with resection, anastomosis, etc) must be documented to ensure payment for an assistant surgeon.
*This response is based on the best information available as of 04/13/17.