From the edits in the Coding Companion for Orthopaedics, assist at surgery is only covered with documentation of medical neccessity.
You don't need ABN if this could be covered by Medicare and no wouldnt think you could bill this if it does not meet Medical Neccessity.
You can appeal with Op notes to prove this to Medicare, but be sure your records clearly states what role the assistant preformed and the need.
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