Wiki Spine Cases with Co Surgeon and Assistant Surgeon

[swallace1]

When the complex spinal operative report states there was a primary surgeon, co-surgeon, and assistant surgeon, can I code and bill for all three? I want to code all the codes for the primary surgeon. Code CPT codes that the co-surgeon was present for, and code CPT codes for the assistant who assisted. One person states that's correct, and that I cannot code any CPT overlap between the co-surgeon and the assistant surgeon. Another person tells me that I can only code for the primary surgeon and the co-surgeon, but not the assistant surgeon, because the co-surgeon will not get paid. Very new to spine coding, so any support would be appreciated.

 

[jdibble]

When the complex spinal operative report states there was a primary surgeon, co-surgeon, and assistant surgeon, can I code and bill for all three? I want to code all the codes for the primary surgeon. Code CPT codes that the co-surgeon was present for, and code CPT codes for the assistant who assisted. One person states that's correct, and that I cannot code any CPT overlap between the co-surgeon and the assistant surgeon. Another person tells me that I can only code for the primary surgeon and the co-surgeon, but not the assistant surgeon, because the co-surgeon will not get paid. Very new to spine coding, so any support would be appreciated.

First, is this a true co-surgeon situation? In a co-surgery, each surgeon must document an OP note detailing the part of the same surgery they did. If they do not both document an OP note, then it can't be billed as co-surgery, and the second surgeon could be the assistant. If one surgeon did one procedure and the other surgeon did another procedure during the same surgical session, then this too is not co-surgery. Each provider will bill the CPT code for what they did and in this case the assistant can be billed. Last, if it is a true co-surgery, the assistant cannot be billed for any procedures that were done by the primary surgeon and the co-surgeon. If the co-surgeon participated in only a portion of the procedures, you can bill the for the assistant on the procedures that the co-surgeon didn't participate. For example, my one doctor does an anterior approach for a cervical arthrodesis, and he usually has another surgeon (a general surgeon) as co-surgeon for this part for the approach, however he does other procedures during this session that, per documentation, the other surgeon does not participate. He can bill the assistant for the other codes, but not the anterior arthrodesis.

 

[chammons]

How would you bill for the add on codes for the assistant surgeon if the primary procedure was done with the co-surgeon?
For example, I am billing 22558, 22585, 22845 and 22853. 22558 and 22585 were both done with a co-surgeon, however 22853 and 22845 were done with the assistant surgeon but I cannot bill only those codes since they are add-on codes.