Ask surgeons to substantiate need for assistants to avoid denials

Why This Topic Matters

Assistant-surgery claims can be denied when documentation does not support medical necessity or payer requirements. Understanding the documentation themes discussed here can help practices reduce avoidable denials and better support reimbursement workflows.

Article Sections

1. Documentation

   Discusses general documentation themes for claims involving surgical assistants and the importance of payer and location variability.

2. Tackling the issue before billing the claim is wise because the payment for assistant surgeons – 16% of what surgeons are paid and 85% of that 16% total if a non-physician practitioner is the assistant – might not be worth the hassle to appeal denials, says Beth Aldridge, CPC, coding manager for Northern California Medical Associates, Santa Rosa, Calif.

   Covers pre-billing planning considerations, including payer inquiry and documentation support for assistant-surgery claims.

3. Sway surgeons to document

   Addresses communication strategies for encouraging surgeons to include assistant-related documentation and highlights broader compliance and appeal concerns.