Billing for Surgical Assistants: What you should know?

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Surgical Assistants

Practices lose insurance reimbursement by incorrectly billing surgical assistants. In such cases, the major reason for claim denials is to use the wrong modifier/ not use the modifier. In this blog, we tried to cover every aspect of billing for surgical assistants including defining surgical assistants, billing guidelines, reimbursement policies, and accurate use of modifiers. Surgical assistance services can be provided by a Health Care Professional other than a Physician (i.e., Physician Assistants (PA), Nurse Practitioners (NP), or Clinical Nurse Specialists (CNS) in accordance with the requirements outlined in Medicare Claims Processing Manual Chapter 12. Surgical assistants include co-surgeons, assistant-at-surgery, and team surgeons.

• Co-Surgeons are defined as two or more surgeons, where the skills of both surgeons are necessary to perform distinct parts of a specific operative procedure. Co-surgery is always performed during the same operative session.
• An assistant surgeon is defined as a physician who actively assists the operating surgeon. An assistant may be necessary because of the complex nature of the procedure(s) or the patient’s condition. The assistant surgeon is usually trained in the same specialty.
• An assistant-at-surgery may be a physician assistant, nurse practitioner, or nurse midwife acting under the direct supervision of a physician, where the physician acts as the surgeon and the assistant-at-surgery as an assistant.
• Under some circumstances, highly complex procedures may require the services of a surgical team, consisting of several physicians, often of different specialties, plus other highly skilled, specially trained personnel, and complex equipment. A physician operating in this setting is referred to as a team surgeon.