If your surgeon dictates that there was an "assist at surgery" present, the primary surgeon needs to dictate the name of the assist and his/her role. Sometimes a primary surgeon needs an assistant BUT it's not always payable. In order to receive reimbursement for the assistant, the procedure would need to warrant an assistant and, most importantly, be medically necessary. For those services that the assistant was instrumental and medically necessary, you would report the SAME code as the primary surgeon. The modifier would be AS or 80 depending on your carrier (check with your carrier as this will become carrier discretion). To determine if the procedure is payable, you would refer to CMS' fee schedule.
0= Assistant at surgery may be paid with supporting documentation
1=Assistant surgery may NOT be paid
2=Assistant surgery MAY be paid
9=Concept does not apply
To find out if the procedure is payable, you would go to...
At the main page...select "Single HCPC Code " and "Payment Policy Indicatiors"...enter (next)
Select "next" again"...
Enter your CPT code in the "HCPC" box
On your drop down key...select "all mofiers"
The 7th column to the RIGHT will provide a status indicator (0,1,2,9) Refer to above for definition.
If the procedure is payable and medically necessary, the primary surgeons documentation must list the assistant names and the ROLE of the assistant. CMS is somewhat vague of what is required for assistant surgery documentaion but if your surgeon wants it paid...it needs to be documented and why. When you receive denials for the assistant, this information will become critical when submitting an appeal...
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