Assistant at Surgery Billing

The first consideration in billing for an assistant surgeon is to be knowledgeable of the surgeries that require assistant surgeons.  The source that I use for this important consideration is the American College of Surgeon’s “Assistant Surgeon Study”.  It should be noted that this is a guideline and ultimately the surgeon and assistant surgeon’s documentation in the operative report will determine if an assistant surgeon will be allowed.  

To bill for an assistant at surgery, the surgeon is required to specify in the body of the operative report what the assistant actually does. It is not sufficient evidence of participation to list the assistant’s name in the heading of the operative report. It is also a good idea to mention in the indications paragraph why there is a need for an assistant.

Once an operative report has been signed by the surgeon, it becomes a legal document and cannot be altered or redone. For claims denied for lack of documentation for assistant at surgery claims, the surgeon can dictate an addendum to the operative report and the claim can be resubmitted.

Medical Coding-why hire a nurse?

Many times we are asked if a nurse with a coding certification is really necessary. NurseValue believes the answer is a definitive yes as medical coding is a complicated, multifaceted process. A nurse is familiar with the medical procedures and services, but is not always aware of the financial piece of the process (coding). We are not the only ones that feel this way! The Department of Labor’s occupational handbook (www.stats.bls.gov/oco/ocos103.htm) recognizes only AHIMA and AAPC certifications. The Office of Inspector General (OIG) requires independent review organizations to have AHIMA or AAPX certified coder for claims review. The state of Hawaii requires certified coding for medical claims review, again recognizing only the CCS and CPC credentials.