Neurosurgery First Assist Billing

[JasonR]

I'm interviewing for a neurosurgery job soon, so I've started re-researching contracts, bonuses, billing, etc, and can across an interesting question. The job is at a Level I trauma center that has no neurosurgery residency. Can I bill under Medicare for first assist because of this? Or does the "qualified resident" thing still come into play. See the AAPA info on first assist billing at a teaching hospital below. How do you neurosurg PAs do this?

 

Medicare restricts coverage for PAs (or physicians) who first assist in a teaching hospital that has a graduate education program in the fields of medicine, osteopathy, dentistry, or podiatry and is approved by the appropriate accrediting body for graduate education. In general, no reimbursement payment is made for first assisting at surgery when it is provided in a teaching hospital that has a training program related to the medical specialty required for the particular surgical procedure and has a qualified resident available to perform the ser¬vice. Hospitals that only participate in the approved programs of other hospitals, or that have non-approved programs are not subject to these restrictions.

However, if these teaching hospitals have no "qualified" resident available, in trauma cases, or if the primary surgeon has an across-the-board policy of never involving residents in the preoperative, operative, or postoperative care of his or her patients, Medicare will cover the services of a PA first assistant. The exact criteria that determine a "qualified" resident are somewhat vague. Some Medicare carriers have said that the primary surgeon can make that judgment. The surgeon may believe that an available resident who has been on duty for an extended period of time may not be the best pair of hands to use in a particular operation. However, to use a PA or a physician for the first-assist duties because a qualified resident is making rounds in another part of the hospital, for example, would probably not be appropriate.

 

Billing for First Assisting at Surgery - American Academy of Physician Assistants (AAPA)

[coloradopa]

I'm interviewing for a neurosurgery job soon, so I've started re-researching contracts, bonuses, billing, etc, and can across an interesting question. The job is at a Level I trauma center that has no neurosurgery residency. Can I bill under Medicare for first assist because of this? Or does the "qualified resident" thing still come into play. See the AAPA info on first assist billing at a teaching hospital below. How do you neurosurg PAs do this?

Basically the physician determines what a qualified resident is. If they decide that general surgery residents are OK to assist then its a problem. If they only want neurosurgery residents then its not a problem since there are none. Given the RCC rules for surgery I can't see a residency allowing the residents to assist with these cases. Also there is an exception if the surgeon never uses residents. Then they are free to use PAs. Basically you can assist depending on what the surgeon decides is a qualified resident.

 

David Carpenter, PA-C

[JasonR]

Thanks David. Makes sense to me. This gives me some good insight when I go for the interview.