Wiki Need help with Medicare assistant surgeon indicator descriptions

[wendelldebbie]

I need clarification on the indicators listed below. I was under the impression that I could only bill procedures with an indicator of 0 or 2 for asst surgeons. This description listed in the Medicare guidelines makes it sound like an indicator of 1 may or may not get paid. Can anyone clear this up....PLEASE!

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.

 

[thomas7331]

The wording in these indicators are meant as instructions to Medicare contractors who are administering the Medicare program as to how they are to reimburse providers, so should be read that way. When it says 'may not be paid', it should be interpreted to mean 'not allowed to be paid'.

 

[Orthocoderpgu]

There are three groups:
Need for an assistant is not questioned. Example would be rotator cuff repair or a joint replacement.
As assistant is not needed. Examples would be trigger finger release or carpal tunnel release.
The third group is that group that is in-between these two categories. Normally an assistant would not be needed, but may be allowed if there is specific medical necessity which needs to be documented. Most of the arthroscopic knee procedures fit into this category. So you would not bill an assistant unless the provider documented a very specific reason why one is needed. Remember, the insurance company is going to have a nurse or MD review the documentation. If there is no specific reason why an assistant is needed, it won't get paid. If the doctor just documents that the assistant was "medically necessary" but does not indicate why, it won't get paid.