Wiki Cosurgery Question

[Christacara]

A neurosurgeon in my office commonly does co-surgeries with another specialty office. During these co-surgeries the two co-surgeons surgeons work together on one primary procedure and then our neurosurgeon and assistant surgeon finish the rest of the surgery together. So far all of our assistant surgeon claims have been denied as they all have add-on codes and no primary procedure. I am confused on how to correctly code for my assistant surgeon's portion of the surgery since I cannot code the assistant surgeon on the only primary procedure code. Here is a breakdown of what is coded.
Primary Surgeon; 22558-62, 22585, 22853, 20937 Assistant Surgeon; 22585-AS, 22853-AS, 20937-AS

 

[cpc2007]

Hi I see you posted this awhile ago, but if you are still looking for guidance on this topic, I would report the 22558.AS for the assistant as well. While there are some guidelines from CMS that state that once a co-surgeon or team surgeon have been reimbursed, an assist is generally not payable, and other payers may follow that lead, with co-surgeries in neurosurgery, there is often a case to be made for that assistant in addition to the co-surgeon. The co-surgeon is often needed to expose the spine, navigating through organs/structures in the abdomen which is beyond the neurosurgeon's expertise. Once the field is exposed, though, the neurosurgery may need a neurosurgically trained assist at surgery to help with the integral parts of an ALIF (e.g., removing the disk material, placing a cage, etc.). In this part of the case, the co-surgeon who opened at the start of the case is outside his/her area of expertise. This is typically the case I've made to payers in the past when coding for both a co-surgeon and an assist on the same CPT. I would encourage your neurosurgeon to specifically document why the neurosurgical assistant was required to have the best shot at supporting the need for multiple physicians including the co-surgeon and assistant. If you code the add on codes without a valid primary, they will deny for that reason since the payer should have edits mapped to prevent paying an add on code without a valid primary CPT.

I hope that helps

Kim
www.codingmastery.com