Wiki Medicare Denying Assistant Surgeon Claims for Signature Requirements

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stinac

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I have had a claim deny recently and in contacting Medicare, I was informed that the primary surgeon's signed report was not the correct and needed documentation. Medicare referenced the signature requirements and stated that a report needed to be signed by the assistant surgeon in order to be reimbursed. Has anyone else run into this?
 
Unless the rules have changed since I did surgical coding that is not correct. I found an old article by Mary LeGrand from Karen Zupko and Assoc. that I used to reference and this is basically what it said...The primary surgeon (surgeon of record) dictates the operative note. He or she should dictate the role, medical necessity, and work performed by an assistant (if one is involved in the surgery). If an assistant surgeon (MD or DO) or an assistant at surgery (PA, NP, or CNS) is used, the primary surgeon is responsible for justifying the presence of the assistant, the medical necessity requiring the assistant’s presence, and the work performed. An assistant, who is billing for his or her services, does not dictate an operative note. If the primary surgeon does not include the information in the operative note, there is no basis to report the assistant’s service. If the bill is denied, the assistant has no documentation to support an appeal.
 
Donna T said:
Unless the rules have changed since I did surgical coding that is not correct. I found an old article by Mary LeGrand from Karen Zupko and Assoc. that I used to reference and this is basically what it said...The primary surgeon (surgeon of record) dictates the operative note. He or she should dictate the role, medical necessity, and work performed by an assistant (if one is involved in the surgery). If an assistant surgeon (MD or DO) or an assistant at surgery (PA, NP, or CNS) is used, the primary surgeon is responsible for justifying the presence of the assistant, the medical necessity requiring the assistant’s presence, and the work performed. An assistant, who is billing for his or her services, does not dictate an operative note. If the primary surgeon does not include the information in the operative note, there is no basis to report the assistant’s service. If the bill is denied, the assistant has no documentation to support an appeal.
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http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R1620CP.pdf

Seems according to this it's up to the MACs to determine what guideline they will stipulate for Assists at Surgery.
 
I've encountered this. It used to be that Tricare had a similar policy. Regardless of what can be said for either case, I'm not sure what is appropriate.

From a record management and HIM perspective, there is not incumbency upon the assistant surgeon to document; on the other hand, many primary surgeons do a very poor job of fulfilling their documentation requirements regarding the presence and need for the assistant, much less what services the assistant performed during surgery.
 
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