To bill as an assistant, the physician has to be actively involved in the procedure. Just being present does not justify billing as an assistant. in addition, the use of an assistant must be medically necessary. If there is no medical justification for an assistant surgeon, very few payers will allow it.
As for co-surgeons, each surgeon must perform a distinct part of the same procedure. If each surgeon performs their own billable procedure, they should each bill for their respective procedure only.
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