Wiki Assistant surgeon

[KarinQuiterio2023]

Good morning all! I have an orthopedic surgeon who is wondering what surgeries can be billed with an assistant surgeon, including fracture surgery. Any help would be appreciated!

 

[csperoni]

The Medicare fee schedule has a column to indicate whether an assistant is allowable. Most CPT books also have an indicator. In general, most fracture surgeries (open treatments) allow an assist, but closed treatments do not.
Here's a good AAPC article about billing for assists: https://www.aapc.com/blog/23393-assistant-at-surgery/
Medicare fee schedule: https://www.cms.gov/apps/physician-fee-schedule/overview.aspx Click start search then agree. You can search for a specific CPT only or by range. Just make sure you select the "payment policy indicator" at the top. Indicator 2 is assist is allowed. Indicator 1 is assist is NOT allowed. Indicator 0 means typically no, but you can appeal an unusual case.

 

[RyanRaichCPC]

Indicator 1 actually means that assist MAY or MAY NOT be paid. 0 means NOT allowed under any circumstances.

The Medicare fee schedule has a column to indicate whether an assistant is allowable. Most CPT books also have an indicator. In general, most fracture surgeries (open treatments) allow an assist, but closed treatments do not.
Here's a good AAPC article about billing for assists: https://www.aapc.com/blog/23393-assistant-at-surgery/
Medicare fee schedule: https://www.cms.gov/apps/physician-fee-schedule/overview.aspx Click start search then agree. You can search for a specific CPT only or by range. Just make sure you select the "payment policy indicator" at the top. Indicator 2 is assist is allowed. Indicator 1 is assist is NOT allowed. Indicator 0 means typically no, but you can appeal an unusual case.

 

[csperoni]

Ryan,
I believe you are incorrect. On my original post, I was using the AAPC article, so I just double checked in case the article was incorrect.
From Medicare Novitas Solutions website: https://www.novitas-solutions.com/webcenter/portal/MedicareJL/pagebyid?contentId=00144529
Assistant at Surgery indicators
0 = Payment restrictions for assistants at surgery applies to this procedure unless supporting documentation is submitted to establish medical necessity
1 = Statutory payment restriction for assistants at surgery applies to this procedure. Assistant at Surgery may not be paid
2 = Payment restrictions for assistants at surgery does not apply to this procedure. Assistant at Surgery may be paid