Wiki Assistant Surgeon Payment Indicators

[MiMimed]

I am hoping someone can clarify this for me. What does "Concept does not apply" under Assistant at Surgery payment indicator mean? They can be paid? They can't be paid? I can't find anywhere that states what those 4 words mean. My physician is stating if the concept doesn't apply then our assistant should be paid. I say if the concept doesn't apply then no payment. I hope someone can direct me to formal information I can present to my doctor either way.

Thank you in advance for your help. I am pulling my hair out at this point.

 

[thomas7331]

'Concept does not apply' simply means that the code is not considered a surgery, so it is meaningless to consider whether or not an assistant at surgery can be paid. This indicator is used for anesthesia, labs, E&M services, medical supplies - just about anything that is not a surgery and therefore there would never be a reason to submit a charge for a surgical assistant. After all, an assistant at surgery is just that - Medicare, or any other payer for that matter, does not make separate payment for the services of an assistant for any purposes other than surgery.

Is there a particular service or example of something specific that the physician feels requires an assistant and should be paid but for which this indicator is assigned? Maybe that would be the best place to start. Occasionally CMS does make an error on the indicator assignments in their fee schedules.

 

[MiMimed]

Thank you for responding so quickly!!

It's for an allograft, code 20930.

My thought is that is has an indicator "9" because there would be no reason for an assistant for this.

Again, thank you so much for your quick response and answer. Very much appreciated!!!

 

[thomas7331]

20930 is actually a status B - 'bundled' - code on the current Medicare Physician Fee Schedule, so it is never paid, whether to a surgeon or to an assistant. In this case, since it is an add-on code, Medicare includes this cost and physician work into the payment it calculates for the base code and never pays this separately. That is the rationale for the 'concept does not apply' in this case - there is no assistant indicator because there is never a payment, so no need to determine if an assistant is required.