Procedure Occurrence Modifier

[Christian_Reich]

Ah! One of the insightful @jenniferduryea-contributions. Nice.

@jenniferduryea

Identifying a procedure performed by an assistant surgeon (using modifier 80). If a surgery involved a surgeon and assistant surgeon, both doctors would submit a claim with the same procedure codes. However, the assistant surgeon would use modifer 80 to denote that his procedures were “assists” and should only be reimbursed at 25% of the fee schedule.

I wonder whether we should actuall swallow the second assistant-claimed procedure and merge it with the first. Remember: The CDM creates a picture of what happened to the patient, not to the doctor or the healthcare system. We could add the cost up for both of these or keep two procedure_cost (in future: cost) records.

@jenniferduryea

US claims can now be submitted with up to 8 modifiers per procedure. However, in the data we have received from data providers, it seems we only get up to the first 4 modifiers.

Can you give an example of what they would combine?