Wiki Multiple Assistants at Surgery

[Dixie123]

I code for Cardiovascular Doctors. They use multiple assistants. If one assistant leaves the OR (for lunch, end of shift etc.) another assistant steps in to replace them. Their documentation meets all the requirements. We have never coded for multiple assistants. We code for the surgeon and one assistant. Our compliance department has told us that we now need to code for ALL assistants.
Attestation
As primary attending surgeon, I performed or was present for key/critical portions of the entire procedure, and I or another attending was otherwise immediately available throughout. ASSISTANTS NAME and SECOND ASSISTANTS NAME served as assistant-at-surgery under my direct supervision by performing parts of the procedure as noted above and/or otherwise assisting with the procedure including exposure, tissue handling, hemostasis, and closure. No surgical trainee was involved in this case.
Can we code for multiple assistants?
Thanks

 

[thomas7331]

You can code for them if the documentation supports it, but Medicare and every other payer I’ve encountered will only reimburse one assistant. So you will be getting denials that will need to be written off, and potentially have overpayments that will need to be refunded, so I would really wonder why your compliance office believes that this is a good idea as it will likely create a lot of extra work with little financial benefit.

 

[amyjph]

I agree with Thomas.

Question - Are they telling you to "code" it for internal tracking purposes but not to bill a claim for it? I have encountered situations where the practice wanted codes entered with the provider name for tracking but no claim was ever filed. It was zeroed out.

 

[csperoni]

Agree with @thomas7331 and @amyjph above. In 25+ years, I have never seen a second assistant claim paid. Most places don't even code them. Some places do code them (not billed) for a variety of tracking reasons.

 

[RaveenaS]

I code multiple assistants from time to time, and if you’re strictly billing to Medicare, you’ll get a denial on the second assist; If there other payers to consider, some do pay for that second assist based on documentations submitted. But anytime there is two+ assists, it’s always reported for tracking purposes, and we do send out the claims to receive the official denial from insurance should their policy/contract state no multiple assistants not payable for the service. (I’ve seen Cigna and Humana commercial insurances pay 2 assists, contractual obligations & adjustments made, of course).

 

[Dixie123]

You can code for them if the documentation supports it, but Medicare and every other payer I’ve encountered will only reimburse one assistant. So you will be getting denials that will need to be written off, and potentially have overpayments that will need to be refunded, so I would really wonder why your compliance office believes that this is a good idea as it will likely create a lot of extra work with little financial benefit.

Thank you, I agree with what you stated.

 

[Dixie123]

I agree with Thomas.

Question - Are they telling you to "code" it for internal tracking purposes but not to bill a claim for it? I have encountered situations where the practice wanted codes entered with the provider name for tracking but no claim was ever filed. It was zeroed out.

It is not for internal tracking purposes, it will be on the claim to payors

 

[CBLENNIE]

The insurance company I work for is only going to allow one assistant surgeon charge and it should be for the assistant who performed the substantiative portion of the procedure(s).