# Assistant Surgeon



## tigger8654

Does anyone have anything in writing that states an assistant surgeon needs to do their own documentation of the surgery?  Or is it enough that the surgeon states that he was assisted by....

Any help would be greatly appreciated!


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## rjconnell

Sorry, I wish that I had something written.  I work in a teaching facility so ours may be a little different. When I bill for an assistant, the primary dicates the op-report with the statement that he was assisted by ____. Since we are teaching we have to have a separate statement that no qualified resident was available and we use a mod 82.  For non-teaching you would probably use an 80. I have not asked my assists to provide any additional documentation the primary op-report should suffice.


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## FTessaBartels

*Co Surg vs Assist Surg*

If the "second" surgeon is truly an assistant - then no separate dictation is required. The primary surgeon merely needs to state "assisted by ____." (and the no qualified resident statemetn if in a teaching hospital). Use -80 or -82 depending on if you're in a teaching hospital setting.

If the "second" surgeon is actually a co-surgeon - then each surgeon must dictate an operative report and you bill the same CPT to both with -62 modifier on both claims.

F Tessa Bartels CPC


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## mmelcam

I read in a previous issue of General Surgery Coder's Pink Sheet that when using the assistant surgeon modifier,  you do not need to dictate your own operative report. You just need to be listed as the assistant surgeon on the primary surgeon's operative report. I don't have access to the issue right now. When I get back to the office, I will let you know which issue it was in.


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## mmelcam

I found the information in the General Surgery Coder's Pink Sheet July 2007, Vol. 6, No. 7 pages 4 - 5. I hope this helps.


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## RebeccaWoodward*

In addition to listing the assistant surgeons name, our payors require documentation for the need and role of an assistant surgeon.  There is an excellent article about this in the January 2008 Coding Edge, page 38.  I made a copy of this article for my surgeons and have had excellent results.


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## spirving

FTessaBartels said:


> If the "second" surgeon is actually a co-surgeon - then each surgeon must dictate an operative report and you bill the same CPT to both with -62 modifier on both claims.
> 
> F Tessa Bartels CPC



Is there a place I can find documentation supporting this statement?  It only makes sense, really.  But I am having trouble documenting this to our surgeons & I'm probably going to be opening a big can of worms with this.  If there is written documentation somewhere, it would definitely help me along.  I'm not finding anything on the CMS or OIG website.  Thanks!


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## RebeccaWoodward*

You're right...I had some difficulty finding this on CMS.  I was, however, able to locate something on my local website.  Maybe this will be helpful.

Appropriate Use of Modifier -62 for Co-Surgery
Recently, CIGNA Government Services Medical Review found that several providers were incorrectly appending the modifier -62 to every surgical procedure code billed during the same surgical session. The AMA CPT 2001 descriptor for modifier -62 says that "When two surgeons work together as primary surgeons performing distinct part(s) of a single reportable procedure, each surgeon should report his/her distinct operative work by adding the modifier -62 to the single definitive procedure code. Each surgeon should report the co-surgery once using the same procedure code. If additional procedure(s) (including add on procedure(s)) are performed during the same surgical session, separate code(s) may be reported without the modifier -62 added."

There are four guidelines that should be used when billing for co-surgery.

Modifier -62 is for use by two surgeons who work together as primary surgeons. 
Modifier -62 should be added to the primary procedure. Each co-surgeon should use modifier -62 only once. It should not be linked to additional codes, including add-on codes. 
Each of the co-surgeons may act as an assistant surgeon for additional procedures. 
Surgeons of the same or different specialty can use modifier -62, but unlike assistant surgeons, each co-surgeon must dictate a separate operative report documenting his/her distinct operative work. The operative report should indicate the medical necessity for having two surgeons act as co-surgeons. 

Look on page 37 on the below link.

http://www.cignagovernmentservices.com/partb/education/video/medicare101/101_mod3.pdf


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## RJG

*More questions on assistant documentation*

I have a question on this.  We were recently told by our State Medical Society that our surgeons should be documenting why they needed an assistant surgeon and what the assistant did.  Our surgeons have come back asking exactly what they should be saying.  They feel it's obvious why they needed an assistant on a major surgery that allows one and they are wondering exactly what and how much they need to document on what the assistant did.  Could someone give us an example of some of the wording they use?


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## LLovett

What we are having our surgeons do is at the beginning of the op report they make a statement like "Due to the complex nature of this procedure, PA John Smith was present and assisted me through out"  or whatever the reason is that they have an assistant. 

Then in the op report itself we have them identify who did what by using terms like I, we, or the assistants name, such as "I opened...." "We then..." "PA Smith harvested the....". 

These are just brief examples but hopefully they will help you.

Laura, CPC


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## FTessaBartels

*Teaching Hospital*

Also, if you are in a teaching hospital you need to specifically state that "no qualified resident was available" ... and you use the -82 modifier.

F Tessa Bartels, CPC, CEMC


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## halebill

Rebecca,

Thank you for your reference to the Jan 2008 Coding Edge article! I am about to have a show down with my surgeons on this very topic. I have pulled this edition and made copies. Now, I'm ready. You always have the most helpful responses! 


Bill


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## RebeccaWoodward*

Thanks Bill!   Always happy to help.  Good luck to you.


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## sodapop

*coding edge January 2008 page 38*



RebeccaWoodward* said:


> In addition to listing the assistant surgeons name, our payors require documentation for the need and role of an assistant surgeon.  There is an excellent article about this in the January 2008 Coding Edge, page 38.  I made a copy of this article for my surgeons and have had excellent results.



Can I get a copy of the coding edge you are referring to?


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## RebeccaWoodward*

sodapop said:


> Can I get a copy of the coding edge you are referring to?



Sure.  What's your fax number?


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## PGARCIA

*Need a copy please*

Could you fax me a copy of the January 2008 Coding edge article.
I need to show one of my doctors the article on docmentation for assistant surgeon.
I would appeciate it.
My fax number is (210) 805-0410..


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## PGARCIA

Rebecca,
Can you send me a copy of the January 2008 Coding edge article.
fax 210-805-0410.
Tks


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## RebeccaWoodward*

PGARCIA said:


> Rebecca,
> Can you send me a copy of the January 2008 Coding edge article.
> fax 210-805-0410.
> Tks



Sure-faxing now-


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## nancygard1

Rebecca,
Can you send me a copy of the January 2008 Coding edge article.
fax 740-446-5677.

Thank you,
Nancy Gard, CPC, COBGC


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## RebeccaWoodward*

nancygard1 said:


> Rebecca,
> Can you send me a copy of the January 2008 Coding edge article.
> fax 740-446-5677.
> 
> Thank you,
> Nancy Gard, CPC, COBGC



On it's way...


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## Kelly19771

*Could I please get a copy as well?*

Hi Rebecca,

Could I please get a copy as well? My fax is 651-968-5900.

Thank you!
Kelly


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## RebeccaWoodward*

Kelly19771 said:


> Hi Rebecca,
> 
> Could I please get a copy as well? My fax is 651-968-5900.
> 
> Thank you!
> Kelly



On its way-


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## mar53tha

*Co Surgeon Article*

Can you send me a copy of the January 2008 Coding edge article too please?

My Fax is 585-258-8086.

Thank You so much!

Martha


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## RebeccaWoodward*

mar53tha said:


> Can you send me a copy of the January 2008 Coding edge article too please?
> 
> My Fax is 585-258-8086.
> 
> Thank You so much!
> 
> Martha



On its way


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## dominono

Would you please fax or e-mail me a copy of that Coding Edge as well? 

(904) 215-4039
Gianni@medicalcodingaudits.com

Thank you,
Gianni Gonzalez, RHIT, CPC, CPMA


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## andrearichelleb

*coding edge article*

hello rebecca, i was wondering if i could get a copy of that coding edge article as well? i know its been a few days and im sure youre very busy, but i would greatly appreciate it 

thanks

Andrea, cpc
fax: 317-338-9567


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## RebeccaWoodward*

andrearichelleb said:


> hello rebecca, i was wondering if i could get a copy of that coding edge article as well? i know its been a few days and im sure youre very busy, but i would greatly appreciate it
> 
> thanks
> 
> Andrea, cpc
> fax: 317-338-9567



On its way...


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## RebeccaWoodward*

dominono said:


> Would you please fax or e-mail me a copy of that Coding Edge as well?
> 
> (904) 215-4039
> Gianni@medicalcodingaudits.com
> 
> Thank you,
> Gianni Gonzalez, RHIT, CPC, CPMA



Faxed copy on its way


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## leslieann74

Rebecca can you send me a copy also.  Leslie Newton  270-780-0479 thanks


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## CHARLENA79

*Coding Edge Article*



PGARCIA said:


> Could you fax me a copy of the January 2008 Coding edge article.
> I need to show one of my doctors the article on docmentation for assistant surgeon.
> I would appeciate it.
> My fax number is (210) 805-0410..



Can I get a copy of this too .... it would be SO helpful? 513.961-1912


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## CHARLENA79

Can anyone that received a copy of this article please fax it to 513.961.1912 Attn: Charlena??


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## RebeccaWoodward*

CHARLENA79 said:


> Can anyone that received a copy of this article please fax it to 513.961.1912 Attn: Charlena??



faxing~


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## CHARLENA79

*article*

Got it....thank you!!!!!


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## nabernhardt

may I please get a copy of this article too. I thought I could just pull it up but its too far back I see.  if you don't mind please fax it to me 308-254-7258
had the wrong number would you mind faxing to this number. I'm sorry


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## Jewel

RebeccaWoodward* said:


> In addition to listing the assistant surgeons name, our payors require documentation for the need and role of an assistant surgeon.  There is an excellent article about this in the January 2008 Coding Edge, page 38.  I made a copy of this article for my surgeons and have had excellent results.



Hi Rebecca,
Could you please fax me a copy of this article? The AAPC website doesn't have this on their archive. (808) 522-4860.
Thank you,
Jewel

Wow! That was INCREDIBLY quick! Thank you again!


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## jweatherall

Good morning Rebecca,

can you please fax me a copy of the article please? 713-512-2289

Attn: Joymesha

Thanks


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## beccap1977

Good Afternoon Rebecca - 
can you please fax me a copy of the article as well 630-933-2740 Attn: Rebecca or email me at Rebecca_Pendergraft@cdh.org? Thanks so much.


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## Mkerzman

Please fax me a copy of the Coding Edge January 2008 page 38 article?
Fax # (605)945-3244


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## nrichard

*Dear AAPC,*

Due to the number of requests, can we get an update to this article in an upcomming addition of Coding Ege?


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## gski

*Fax or email request*

Can someone please fax or email me this January Coding Edge 2008, page 38?  Thank you so much! Gina  231-487-3082 or ggrubinski@northernhealth.org


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## RebeccaWoodward*

I believe I have captured everyone...


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## gski

Thank you Rebecca!!  I really appreciate your assistance!


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## mlicata

Rebecca can you fax me a copy of the article. My fax number is 314-966-4802 attn Maria

Thank you


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## csindberg

Rebecca, 

Can you also fax me a copy of the article.  My fax number is 608-833-1413, Attn:  Cheryl 

I really appreciate your assistance!


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## tnksutherland

Rebecca,  
you have been great in sending copies all over, and I agree that this article should be re-posted in another Coding Edge with this kind of demand.

So if I may jump on the bandwagon - would it be possible for you to send me a copy of this article (408) 984-2456

Thanks so much


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## RebeccaWoodward*

Faxed.  Please let me know if you did not receive it.


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## ckstein

Rebecca, could you send one more to me? 734-647-5212

thank you


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## acarpenter

Hi Rebecca, could you also fax this to me at 937-415-9190.  Thanks in advance for your help.


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## dwalsh68

If someone wouldn't mind, please fax  this article to me as well.  I really appreciate it.  609-815-7814

Thanks,
Denise


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## RebeccaWoodward*

Think I got everyone...


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## suzi0423

*SKellerCPC*

I am researching co-surgeon vs assistant surgeon for my boss.  I see there is a Coding Edge article in January, 2008 issue, but the PDF archives only go back to April, 2008. I think *RebeccaWoodward* faxed it to several coders, also *mmelcam*found information in the General Surgery Coder's Pink Sheet of July, 2007.  If anyone has these available and could/ would please send to me at my e-mail skeller@pshfay.com.  Thank you.  This forum has great contributors.


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## RebeccaWoodward*

Can I fax it?


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## mstallings

*assistant  Surgeon*

I have my surgeon's note how the assistant helped etc. This should be documented...CMS guidelines state they should dictate more than "we" did the approach etc. Check CMS guidelines. Also, if you need to do an appeal- if there is a intra-op report, the time in and out should be noted for each person in the O.R. I use this to as proof of assistance. Hope this helps. I agree with everyone else though, assistant surgeon's do not have to dictate separate note and CMS should speak to this.


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## deickbush

*Coding edge article*

If anyone can fax or email me this article from the Coding Edge, I would really appreciate it. This discussion has just come up with our surgeons and I'd like to provide them something. Thanks!! 

Denise Eickbush
F 316-858-1905
email deickbush@kjsi.com


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## RebeccaWoodward*

faxing...


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## janice.moore

*article*

Rebecca,  could you fax that article to me?  
Is there a way to get copies of past articles through the AAPC?

Fax: 414-768-5423
Janice Reynolds, RN, CPC, CPMA, CHCA
manager-Coding/Auditing, Provider Education


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## jtb57chevy

Rebecca, could fax the article to me as well?
Thanks so much!

Fax: 606-325-0375
Terri Blevins, CPC


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## rblunt2127@gmail.com

RebeccaWoodward* said:


> Thanks Bill!   Always happy to help.  Good luck to you.


Rebecca, can you fax me a copy of the January 2008 Coding Edge article 
fax 814 865-4054
thanks, Becky


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## RebeccaWoodward*

Sure thing...


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## adk01a

*assistant article*

I was wondering if anyone could fax the article that was published in the January 2008 on assistant surgeon to me at 855-440-6493 and 864-850-9848 or email to me at adk01a@gmail.com


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## EZANOTTO

Hello ~ Could you please fax me a copy as well, please. 

Thank you, 
Elena Zanotto, CPC
Fax# 408-885-7307


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## clwhelan

If someone would please email me a copy of the article I would appreciate it.  
liwhelan@childrensomaha.org


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## WIMargie

*January 2008 Coding Edge article*

Rebecca - would you be able to fax me a copy of the article also?
Much appreciated!  
fax # 920-632-0494  

Thanks,
Margie


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## ksnively

*January 2008 Coding Edge article*

I would greatly appreciate it if someone could fax or email me a copy of the article as well.  609-267-1044 or kimberly.snively@gmail.com

Thank you,
Kim


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## Lujanwj

Can someone attach the documentation to this thread?  Replay and click the paper clip to attach a file.  Probably be better for everyone that needs it.  

Thanks in advance


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## tapeni

Hi, Can you fax me a copy too please
Fax # 937-641-7381
Thank you!


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## RebeccaWoodward*

tapeni said:


> Hi, Can you fax me a copy too please
> Fax # 937-641-7381
> Thank you!




I believe I have captured everyone...


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## Jenuine

Rebecca,
I tried to find the January 2008 article you mentioned and couldn't find it.  If you get a free moment would you be able to fax a copy of that article to me?  I would really appreciate it.  My fax is 813-643-2457.

Thanks so much
Jen


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## RebeccaWoodward*

Jenuine said:


> Rebecca,
> I tried to find the January 2008 article you mentioned and couldn't find it.  If you get a free moment would you be able to fax a copy of that article to me?  I would really appreciate it.  My fax is 813-643-2457.
> 
> Thanks so much
> Jen



on its way


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## cansas

Is there anyway I could get a copy as well 740-374-0723?  I am trying to explain this to some of my surgeons right now.

I greatly appreciate it.

Thanks
Cansas Riggenbach, CPC


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## slc112071

Could I please get a copy of this as well?  My fax is 940-764-7239.  

Thank you!!!!

Sherri Creed, CPC


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## anarrin

If someone one could email me a copy of the article from the 2008 Coding Edge that would be great.  It doesn't seem to be online anymore.  anielsen@affinityhealth.org

Amy Nielsen, CPC


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## armen

Can I please get a copy of this as well?  fax: 404-856-3893


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## jdibble

Hi Rebecca,

If you are still faxing copies could I have one also? 

Fax #973-383-5368

Thanks!


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## MBRAMEL

*mb billing*

I would love to have a copy of this article..If anyone still has and could fax to me I would greatly appreciate it.  My fax is 502-868-6107.  We are just beginning to bill for assistant.
Thankyou


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## RebeccaWoodward*

MBRAMEL said:


> I would love to have a copy of this article..If anyone still has and could fax to me I would greatly appreciate it.  My fax is 502-868-6107.  We are just beginning to bill for assistant.
> Thankyou



Tried 2x...couldn't get it to go through


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## RebeccaWoodward*

anielsen said:


> If someone one could email me a copy of the article from the 2008 Coding Edge that would be great.  It doesn't seem to be online anymore.  anielsen@affinityhealth.org
> 
> Amy Nielsen, CPC



Amy, I'll need a fax #. 

Thank~


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## RebeccaWoodward*

I think I faxed everyone; maybe even twice.


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## jessa410@hotmail.com

Rebecca, 

I would also love a copy of this article to share with our providers. My fax number is 675-4570.  If possible, please, put it to my attention.  I am in a large office with multiple people sharing the same fax.

Thank You,

Jessica, CPC


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## Lujanwj

A copy would be awesome.  My direct fax is 303-468-0729 

Thanks in advance


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## Lujanwj

Thanks Rebecca. 

I've attached it as a PDF for future downloads.


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## RebeccaWoodward*

*Nice!*



Lujanwj said:


> Thanks Rebecca.
> 
> I've attached it as a PDF for future downloads.



Thanks so much!


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## karadbutler

*january 2008 article/ assists*

Wow, this seems to be an issue everywhere, including my office. I would appreciate if someone could email me the article from January 08, i also tried to go back in the archives to find it. kara.butler@spectrumhealth.org
Thanks so much! 

Kara


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## karadbutler

N/M, i see the link 

Kara


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## Jewel

Hi Rebecca,
Could you please fax me the article again? I lost my copy. 
Thank you in advance!
(808) 522-4860.

Thanks,
Jewel


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## pennykat2

*Assistant Surgeons*

Hi,
 New to the website and saw the many postings about assistant surgeons in a prior coding edge and other General Surgery Coder's Pink Sheet July 2007, Vol. 6, No. 7 pages 4 - 5. January 2008 Coding Edge, page 38
Does anyone still have these handy? Please fax (305) 535-7919 or email pennykat3@comcast.net

Thank you,
PK3


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## SHERYL SIMPSON1

If possible can someone please fax me a copy of the coding edgde article. Would really appreciate it. Many thanks in advance.
Sheryl
516-632-4605


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## Bsivera

Hi there-

Can I get a copy of this as well?  My email is bsivera@yahoo.com  Thank you!!


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## wcarmignani

Not sure who else may need it but I have it as well. Message me your email if you need it.


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## RebeccaCross*

If you look further up in the posts', you'll see that it's been posted as an attachment for downloading...


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## davidjnagy

*Co-surgeon and Assistant Surgeon*

Can anyone tell me where I can find a reference citing that only 2 providers can be paid for a given CPT. Example: 2 co-surgeons bill for 22558. The a 3rd provider , that is a physician assistant also bills for 22558. My understanding is that only 2 providers can be paid for a given CPT. Not sure where this refence can be found. Medicare, CPT, AMA.
Thanks,


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## DebHill1958

*Co-Surgeon and Assistant Surgeon*

I too am having issues with surgeons only putting "Assistant Surgeon: Dr. Blah" and thinking this is enough to justify them getting credit for wRVUs. Even from a medico-legal standpoint, shouldn't each physician state exactly what they did? I mean if Dr. A does a C-section but Dr. B put in the sutures and the patient develops some infection in the incision, wouldn't they want to know who put the sutures in? This seems like a no-brainer to me. I think they should have to establish medical necessity for their presence even if it's one of the procedures that is already approved to have an assistant surgeon. At a minimum the primary surgeon should have to dictate in his note why Dr. B was needed and exactly what he did as an assistant. 

When I told the hospital administrators that assistant surgeons are only reimbursed 16% of the Medicare allowable and suggested their wRVU should reflect this as well, the response from the surgeons was "well then I just won't scrub in on those cases anymore". So tell me, how medically necessary was it that they be there in the first place.


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## jnaa70

Hi.  Can I also get a copy of this article from the Coding Edge from January 2008. page 38, as well as General Surgery Coder's Pink Sheet July 2007, Vol. 6, No. 7 pages 4 - 5.   The link for the coding edge archives is not taking me there.  I would appreciate if someone can e-mail me a copy :  rustig06@yahoo.com.

Appreciate any lead.  Regards,

Jennifer A.


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