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Wiki Assistant at Surgery

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vergor

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Kissimmee, FL
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Hello,

Is there any book or program that can help me with knowing how many assistants can be used to a procedure?

My physician performed an Pulmonary Endarterectomy (33916) he has three assistants listed.
 
Team surgeons aren't permitted for this code. Does the documentation say why 3 were needed? Are they all MD's? If so, are they of the same specialty? Does the documentation state what each of them did?

There are requirements for team surgeons, co-surgeons, assistant surgeons... the procedure has to allow for them, first off. There has to be a medically necessary reason for the additional help. There has to be documentation by all surgeons, each stating the specific portion of work that they did and who else participated, etc. The multi-specialty rule needs to be considered.

To maybe help answer your question, the best place to check to find out if multiple providers can perform a procedure, review the NCCI edits for that procedure code. If multiple surgeons are allowed, it will also tell you what's needed to support payment (documentation and medical necessity). There's no book or any kind of across the board answer. Generally speaking, it's all based on each CPT code, the edits, and the documentation.
 
For procedures that allow an assistant, Medicare will pay the first assistant claim that is received and will automatically deny the others. They do state that this can be appealed if there is documentation of medical necessity to support the additional assistant, so you could give it a try if you think you have a persuasive case. Most other payers that I have worked with also only allow one assistant.
 
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