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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