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Does assistant surgeon need to be in OR?

  1. Question Does assistant surgeon need to be in OR?
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    I work for an Orthopedic practice and they are under the impression that as long as their PA checks on the pt in post op area they can bill for them as an assistant surgeon for that case. This just seems wrong but I cannot find any documentation stating the assist actually has to be in the room helping. Please help!

  2. #2
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    I don't know about you but that kinda sounds like fraud to me--as the post op care is included in the global service. Just as if another MD sees that patient for a post op you would not put that MD as a surgery asssit. I believe that they would need to actually assist in the actual surgery--but again I can't find anything that actually says that either--to me it seems like common sense.
    Tina Wosmek CPC, COSC

  3. #3
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    I agree (above) common sense

    you are charging a procedure code, so you are saying he assisted with a procedure, you are not saying he assisted with post op visit. Not only are the physicians supposed to document an assistant surgeon they are supposed to document why they needed an assistant (medical necessity) AND documentation of what the assistant did.

    this topic has been discussed in this forum before, and a suggested article from the january 2008 coding edge is recommended reading. The original post was 06.18.08 aapc forums, maybe you could send private email to the person who posted the article and get a copy, if you dont have one, i dont have mine today.

    You could just call your payor and see what their policy is.

  4. #4
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    Following up with the patient in the post op area does not support billing for physician assisant surgical services. Most carriers, including Medicare, are becoming more and more strict on the documentation of the role of the assistant. What are your physicians documenting if the assistant is not actively participating in the surgery?

    "As defined by the American College of Surgeons, the surgical assistant provides aid in exposure, hemostasis, closure, and other intraoperative technical functions that help the surgeon carry out a safe operation with optimal results for the patient. In addition to intraoperative duties, the surgical assistant also performs preoperative and postoperative duties to better facilitate proper patient care. The surgical assistant to the surgeon during the operation does so under the direction and supervision of that surgeon and in accordance with hospital policy and appropriate laws and regulations."

    http://www.ama-assn.org/ama1/pub/upl...assist0809.pdf

  5. Default
    Quote Originally Posted by katwright View Post
    I work for an Orthopedic practice and they are under the impression that as long as their PA checks on the pt in post op area they can bill for them as an assistant surgeon for that case. This just seems wrong but I cannot find any documentation stating the assist actually has to be in the room helping. Please help!
    Sounds WRONG to me....Read the Modifier 62 description in the CPT book Appendix A

    A lot of times I find coding is a common sense decision...It sounds wrong..trust your gut feeling...
    Last edited by CSig76; 04-15-2011 at 01:33 PM. Reason: CPC-A

  6. #6
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    No Way! My office began coding for a PA about a year ago and I have done a lot of research through the AAPC forums and posting my own questions and, through that, I have learned:
    PA assist at surgey is just that an assist AT surgery. Through prior posts I have learned that the physician must clearly document in the operative report what the PAs role was during the surgical procedure, not simply that they were present. My Ortho has his PA present at nearly every surgical procedure; however, his prefernce that she be present does not make it medically necessary for her to be there. Check the forums by looking up Physician Assistant billins-there if a wealth of information.

  7. #7
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    Quote Originally Posted by katwright View Post
    I work for an Orthopedic practice and they are under the impression that as long as their PA checks on the pt in post op area they can bill for them as an assistant surgeon for that case. This just seems wrong but I cannot find any documentation stating the assist actually has to be in the room helping. Please help!
    What kind of documentation other than the definition do they need? Modifier AS definition reads "Physician assistant, nurse practitioner, or clinical nurse specialist services for [B]assistant at surgery[B]" (the bold is my emphasis), just as Modifier 80 is Assistant Surgeon. In order to bill as an assistant at surgery, the provider must be present and be more than just an extra pair of hands.

    Speaking from the insurance company point of view, if they persist in this, once you explain to them that they are wrong, this could indeed be fraud. I would suggest that if they don't want to take your word, contact their specialty society, the AMA, or CMS.

    Hope this helps,
    Last edited by cmcgarry; 04-15-2011 at 01:46 PM.
    Lucinda (Cindy) McGarry, CPC-P
    Applications Specialist
    Avera Health Plans
    Education Office Sioux Falls SD Local Chapter
    Past President Sioux Falls SD Local Chapter

  8. Default
    Thank you all! I knew it wasn't right but they don't listen to anything without written evidence.

  9. #9
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    I totally know how you feel!!!
    Tina Wosmek CPC, COSC

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