# Teaching Assistant services



## JDHumenay (Aug 16, 2013)

Hi folks!
  I have an MD who has taken to listing 3 people as his assistants on many procedures. Currently, the MD lists 2 residents, and the attending for the 1 of the residents. I'm seeking further clarification from the MD as to why 3 people were medical necessary for the procedure.
 My question would be, how can I code for these assistants? They are requesting coding if possible (of course), but I'm unable to find really clear guidelines to point me in the right direction. 
 Opinions/recommendations w/ citations appreciated! Thanks!


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## JG24 (Aug 17, 2013)

Before I even tried to code it, I would check with the insurance carrier to see if they allow for an "assistant" on the surgical procedure.  While the surgeon may think he needs an assistant, many of the insurance carriers are do not pay for surgical assistants anymore and if they do approve one, you should bill the exact same codes for the assistant that you bill for the primary surgeon with the appropriate modifier added.  I suggest that you find a time to instruct your physician that it may be his decision to have an assistant BUT it is up to the insurance carrier as to whether or not it is a paid benefit.  I don't see a situation where an insurance carrier would ever approve of multiple assistants on a surgical procedure


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## FTessaBartels (Aug 19, 2013)

*Teaching hospital?*

NO bills are submitted separately for resident/fellows who serve as assistants in surgical cases as part of their training.  

If another attending serves as an assistant, the primary surgeon must explain in the body of the operative note why the expertise of that surgeon was necessary when there were residents obviously available to assist.  

Teaching hospitals sometimes get very complicated cases due to the specialists available in those institutions.  Occasionally such surgeries require two (or more) attendings as well as a resident/fellow.  

BUT this is NOT the norm - it is the rare exception.

Hope that helps.

F Tessa Bartels, CPC, CEMC


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## JDHumenay (Aug 22, 2013)

FTessaBartels said:


> NO bills are submitted separately for resident/fellows who serve as assistants in surgical cases as part of their training.
> 
> If another attending serves as an assistant, the primary surgeon must explain in the body of the operative note why the expertise of that surgeon was available when theree were residents obviously available to assist.
> 
> ...



Very helpful. Thank you! Can you offer a citation for me? I'm having trouble finding something from CMS.


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## JDHumenay (Aug 22, 2013)

JG24 said:


> Before I even tried to code it, I would check with the insurance carrier to see if they allow for an "assistant" on the surgical procedure.  While the surgeon may think he needs an assistant, many of the insurance carriers are do not pay for surgical assistants anymore and if they do approve one, you should bill the exact same codes for the assistant that you bill for the primary surgeon with the appropriate modifier added.  I suggest that you find a time to instruct your physician that it may be his decision to have an assistant BUT it is up to the insurance carrier as to whether or not it is a paid benefit.  I don't see a situation where an insurance carrier would ever approve of multiple assistants on a surgical procedure



I do check the CCI edits for assistant allowance before coding. I'm in the unique position to be purely coding, without worry for carrier - as long as I meet federally laid out guidelines. 

But I agree, I currently have a note out to the MD asking him to further clarify why so many extra hands were necessary for what appears to be a simple procedure.  MY guess is they were actually just observing.


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