Neurosurgery Coding Alert

Question: I understand there must be documentation in the operative note regarding the tasks the assistant performed during the case as well as which cases are eligible for reimbursement for an assistant at surgery. But, if I use a PA for some of the case, say positioning, prep and drape, exposure and closure and then use a Non-ACGME fellow for the rest, e.g. in a spine case, assisting with the laminectomy and fusion portion, which can I bill the first assist for? PA or fellow? When the fellow is assisting in a case without a PA, we bill for the fellow as a first assist. So, which of the two, PA or fellow, can I bill as first assistant if they were both involved in the same case but performed different functions? We are a Non-ACGME fellowship.

South Carolina Subscriber

Answer: Non-ACGME fellows are considered, for the sake of terminology, a junior faculty member or junior attending, according to Suzan Hauptman, MPM, CPC, CEMC, CEDC, AAPC Fellow, senior principal of ACE Med in Pittsburgh. They have their license, have been through residency, and have decided to get additional training. They must be a direct hire by the practice or medical group as they are not receiving subsidies for the training of said fellow.

“Thus, if a PA does a portion of a procedure and the fellow does another portion, it must be decided by the attending, who will be billed,” explains Hauptman. “Billing for the fellow may involve a higher reimbursement depending on how the payer views the PA.”

If there is also a resident in the room, then no one can be billed as the assistant unless the attending explicitly lays out why the resident was not qualified, Hauptman adds.

Don’t forget: The details of what the assistant did should also be very clear within the documentation, Hauptman cautions. The two assistants are considered one person in the eyes of the payer. They cannot both be billed.