Chapter 4
Section 4.1
Assistant Surgeons
Issue Date: April
5, 1989
Revision:
1.0 DESCRIPTION
A
physician, dentist, podiatrist, certified physician assistant, certified
nurse practitioner, or certified nurse midwife acting within the
scope of their license who actively assists the operating surgeon
in the performance of a covered surgical service.
2.0 POLICY
2.1 Services of
an assistant surgeon are covered when:
2.1.1 The surgical procedure is of the complexity
and seriousness as to warrant a surgical assistant (other than the
surgical nurse or other such operating room personnel).
2.1.2 Interns,
residents or other hospital staff are not available to provide the
surgical assistance.
2.1.2.1 The
operating surgeon may be required to certify in writing to the non-availability
of a qualified intern, resident, or other house physician.
2.1.2.2 In lieu of the
operating surgeon’s certification, the contractor may maintain an
annually updated list of hospitals that have certified that they
do not have internal staff available at any time to perform the
services of assistant surgeons.
2.1.3 Review is required to ascertain whether
the services of an assistant surgeon are covered when:
2.1.3.1 The surgical
assistance occurred in a hospital that has a residency program in
a specialty appropriate to the surgery;
2.1.3.2 The surgery
was performed by a team of surgeons;
2.1.3.3 There were multiple
assistant surgeons; or
2.1.3.4 The assistant
surgeon is in partnership or practice with the primary surgeon.
2.2 Assistant surgeons
used for Percutaneous Transluminal Coronary Angioplasty (PTCA) or Percutaneous
Transluminal Coronary Arthrectomy may be covered if criterion in
paragraph 2.1.2 is
met.
3.0 EXCLUSION
Standby
assistant surgeons.
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