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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