Search Search

Wiki assist on surgery

Create Wiki
J

Jackfish66@aol.com

New
Messages
5
Location
Orchard Park, NY
Best answers
0
Recently I have received from highmark BC they are refusing to pay for the assist fees on a hernia repair because "the submitted medical records indicate the name of the assistant at surgery; however the operative report did not indicate how the assistant at surgery actively assisted the operating physician. " Has anyone else seen this? Any idea what they are looking for specifically? It is my understanding that the hospital requires an assist on all surgeries. I have tried to call Highmark to ask where I can find the information that they feel is needed but to no avail.
thank you
 
This is one of those items that I believe for years and years that many physicians have not been documenting well. It was always a requirement to not only list the name of the assistant, but their role/what they did during the surgery. It could be literally one sentence (assuming it's not a teaching hospital - which would then also require a statement about a resident not being available). Simply listing the assistant's name is not sufficient.
Dr. ASSIST was essential to safely perform the case and present throughout the procedure and assisted with retraction, suction and irrigation, bleeding control, and skin closure.
Some surgeries also require an explanation of why an assistant was needed.

Here is an old, but still accurate AAPC article about assist at surgery in general: https://www.aapc.com/blog/23393-ass...lQUEPf4liDqb8p2n2qUYMYUMEe-MrzI1dh8EYxRAje5Re

And this policy by Highmark: https://www.highmarkhealthoptions.com/content/dam/digital-marketing/en/highmark/highmarkhealthoptions/providers/medical-payment-policies/HHO-DE-RP-1129_Assistant Surgeon_05242023.pdf
 
Agree with Christine. Song as old as time. Debate I have had with providers for years and years. Even if the CPT is an "always allows assist" type; the provider MUST actually document what the assistant did. It is not enough to just have their name in the top of the report. Why is an assistant needed if you don't state what they did and why it was necessary? Why should it be paid if a surgical or scrub tech or "lower" level assistant could have been used? It doesn't matter if the "hospital requires an assist on all surgeries". They must document what the assistant did to actively assist.
Note some payers may have different assist at surgery coverage than CMS or others.

Examples:
"The "assistant at surgery" provides more than just ancillary services. The operative note should clearly document the assistant surgeon's role during the operative session."


"...providers need to document in their operative report why an assistant is required for the surgery. If the chart notes are requested for review, that information must be documented. a. The operative report should document, with specificity, the activities the assistant surgeon performed."

Specifically, when a PA actively assists a physician in performing a surgical procedure and furnishes more than just ancillary services, the PA’s services are eligible for payment as assistant-at-surgery services.

An Assistant-at-Surgery actively assists the Physician performing a surgical procedure.
Q: What if hospital bylaws require the attendance of an assistant for all procedures? A: No exceptions will be made to the policy to accommodate hospital bylaws. The NPFS published by CMS will be used to determine benefits for Assistants-at-Surgery.
 
You must log in or register to reply here.
Top