Wiki Assistable Coding

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I have a physician that is performing a abdominal wall hernia repair. Another physician within the practice is going to assist him in this procedure. Is this billable?:D
 
Assistant surgeon

This is billable but ONLY on these conditions....
First the main surgeon has to explain in his documentation that a qualified resident was not available. Then he has to be explicit about what the assistant actually performed. Then you can code the assistant's service with an 80,81 or 82, whichever applies.
 
Most of the MACs have a fee schedule lookup, here is an example: https://www.novitas-solutions.com/webcenter/portal/MedicareJH/FeeLookup
You enter the code and look at the assistant-at-surgery status indicator.

Some of the major payers have their own published lists which may or may not always match CMS.
United commercial follows CMS: https://www.uhcprovider.com/content...imbursement/COMM-Assistant-Surgeon-Policy.pdf
Anthem too: https://www.anthem.com/docs/public/inline/C-08006.pdf
Most of the coding applications such as Encoder have it built in to the code searches.

What dphillips comment pertains to is teaching facilities, but it wouldn't have to be documented that a qualified resident was not available if you are not in a teaching facility. Providers should be explicit about exactly what the assistant at surgery did and not just list a name in the header, even if the code is "always allows" an assistant.
 
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