Orthopedic Coding Alert

Question: How do I find the rules regarding assistant surgeons' fees? I have the Medicare list of appropriate CPT codes for which an assistant may bill. What documentation is necessary?

Elizabeth Crozier
Gainesville, Fla.

Answer: Medicares rules regarding assistant surgeons are well defined. Information is available from a number of sources. If you have a Medicare Part B Reference Manual in your office, look in the chapter on Global Surgery and Related Issues for instructions on eligibility, fees and reporting. Your manual also will have an appendix that lists the surgical procedures that are eligible for assistant-at-surgery services. Documentation is only required for CPT codes that appear in bold type. For these codes, you will need to submit a letter from the primary surgeon explaining why an assistant surgeon was needed. Be aware that the Health Care Financing Administration (HCFA) revises the assistant-at-surgery list periodically, so check with your carrier to verify whether a specific CPT code is eligible for reimbursement.

Information on Medicares rule for assistant surgeons is also available on the Internet. Check out HCFAs Web site at www.hcfa.gov. Many of the local carriers also have Web sites where Medicare policy information is available to print or download. If your carrier does not have a Web site, you can request a copy of the Medicare Policy Bulletin on Assistant Surgery/Assistant Surgery in Teaching Hospitals Eligibility from the Freedom of Information Office.