Looking for MSP billing software for certified surgical assistants? Look no further.

Simple MSP Billing Software for Certified Surgical Assistants

Claim Manager CSA is perfect MSP billing software for certified surgical assistants who want to do their billing themselves.

To Bill for Certified Surgical Assistance

1. Select surgical assist code

  • T70019/20 + 00198 – “C” procedures or medical necessity
  • 00845/6 – Cardiovascular
  • 07915/17/20 – Open heart surgery 1st as.
  • 07916/18/20 – Same 2nd assistant
  • G04710/1/2/3 – Some obstetrics & gynecology
  • 00195/6/7/8 – General assists

2. Add 1st assist of the day

  • 51194 – Orhtopaedics
  • 00845/6 – Urology
       

3. Add out-of-office hours premiums

  • 01200/1/2 – Call-out charges
  • 01210/1/2 – Continuing care surcharges
       

Step 1. Select Surgical Assistance Billing Codes.

Depending on your specialty and the procedure(s), select surgical assistance billing code(s).

1.1. Certified Surgical Assistant Billing Codes.

If assisting with the procedure(s) with prefix “C”, bill T70019/20.

T70019  – Certified surgical assistant for up to one hour – $251.70 Note: Time is calculated at the earliest, from the time of physician/patient contact in the operating suite.
T70020 – Time after one hour of continuous certified surgical assistance for one patient, up to and including 3 hours of continuous surgical assistance for one patient
  • each 15 minutes or fraction thereof – $26.28
Notes: i) After 3 hours of continual surgical assistance for one patient, bill under fee item 00198 (time after 3 hours of continuous surgical assistance for one patient, each 15 minutes or fraction thereof). ii) Please indicate start and end time of service on claim.
00198 –  Time, after 3 hours of continuous surgical assistance for one patient
  • each 15 minutes or fraction thereof – $27.80.
If a Cardiology assist is required with the procedure C33076, may bill Cardiology Assist Fee Items 00845 (first hour or fraction thereof) and 00846 (after one hour, each 15 minutes or fraction thereof) @50%. C33076 – Percutaneous balloon valvuloplasty for aortic stenosis (composite fee) -$600.00. Notes: i) Includes all necessary catheterizations, angiography (00801, 00810, 00812, 00827, 00871, 00888, 00889, 33030), angiocardiography, intraarterial cannulation, right heart catheterization, retrograde left heart catheterization, pulse tracing (intravascular), temporary pacemaker, any medically necessary diagnostic imaging (e.g.: Intra-cardiac ultrasound), CVP, arterial lines, blood pressure measurements, and any pharmacological infusion and studies, blood sampling, blood analysis and interpretations done in association with procedure. ii) 30 days pre and 48 hour post-operative visits in hospital included. iii) 00840 (percutaneous trans-luminal coronary angioplasty) and 00841 (direct coronary angiography) may be billed at 50% if done with this Procedure.
According to MSC Payment Schedule, T70019/20 can be billed for assistance in the fields of
  • obstetric and gynecology
  • orthopaedics
  • general surgery
  • vascular surgery
  • oesophageal surgery
  • thoracic surgery.
Fee item C06159 (tram flap reconstruction of mastectomy defect – $1,002.09) is performed. The surgical assistant time is from 0800hrs. to 1210hrs., payment would be:
  • From 0800hrs. to 0900hrs.,1 x fee item 70019 (Certified surgical assistant).
  • From 0900hrs. to 1100hrs.,8 x fee item 70020 (time, after one hour of continuous certified surgical assistance for one patient, up to and including 3 hours of continuous surgical assistance, each 15 minutes or fraction thereof).
  • From 1100hrs. to 1210hrs.,5 x fee item 00198 (time, after 3 hours of continuous surgical assistance for one patient, each 15 minutes or fraction thereof).
When billing for the assistance with the procedure whose billing code starts with letter “C”, no medical necessity letter is required. The surgical assistant does not need to provide any comments in the claims. The claims will be adjudicated automatically.

To bill T70019/20 for the procedures without “C”

The specialist’s assistant listings (T70019/20) apply only to surgical procedures having unusual technical difficulties identified and documented by the primary surgeon in a detailed note record as necessitating the services of a certified surgical assistant. The general assistant listings are applicable to all other situations where surgical assistance is necessary. (Also see Preamble B. Definitions, Prefixes to Fee Codes). – MSC Payment Schedule Index. D5.4.(iv). An article by Keith J. White, MD, in BCMJ, Vol. 57 No.1 January, February 2015, page(s) 31, provides the following billing tips.   In order to meet the criteria to bill a certified surgical assist:
  • A detailed explanation needs to be provided in the operative report or a separate letter sent to MSP by the primary surgeon. Reports and letters can also be faxed to MSP at 250 405-3593.
  • The letter by the surgeon to MSP should include the following: Name, PHN, DOB, DOS, procedure(s) performed (include fee code) and should describe the complexity of the procedure, such as comorbidities, obesity, and other factors that require a certified assist versus a regular assist.
  • It is recommended that you note the start and end times in your operative report in the event you are audited.
If you simply state “A certified assist was required” or “a medical necessity” with no explanation as to the complexity of the procedure, the certified surgical assistant fee could be reduced to a surgical assist fee (fee items 00195, 00196, or 00197).
1. When billing  70019 for the assistance with the procedure whose billing number does NOT start with letter “C”, the surgical assistant is advised to include the following information in the comment:
  • a note that the operative and medical necessity report was faxed by the surgeon,
  • the medical necessity information (optional).
2. No comments or additional information is required for claims with billing codes 70020 and 00198. 3. The payment number of the surgeon is not mandatory in the referred to/by field. 4. All claims with code 70019 for procedures without “C” are processed manually, so including the comment will not delay the adjudication process.
Example 1. The operation performed is fee item V70720 (cholecystoenterostomy with gastroenterostomy) $853.81. Fee items 70019 x 1 and 70020 (from 1200hrs. to 1330hrs.) are billed by the assistant.  The operating surgeon has not provided an explanation outlining the unusual technical difficulties unique to the patient. Fee item 70019 would be reduced to fee item 00197 with explanatory code QS QJ and fee item 70020 would be refused with explanatory code QS as fee item 70020 is only payable in conjunction with fee item 70019:
  • QS (70019/70020 requires confirmation of medical necessity from the surgeon.)
  • QJ (Adjusted to agree with the surgical/assist fee item paid for this date of service.)
Example 2. The operation performed is fee item V70720 (cholecystoenterostomy with gastroenterostomy) $853.81. The patient has massive adhesions due to Crohn’s Disease and the operating surgeon has indicated this in a note record on the claim submission or in a letter. In this case the massive adhesions would cause unusual technical difficulty for the surgery. Therefore; fee item 70019 is payable. Example 3. The operation performed is fee item V70720 (cholecystoenterostomy with gastroenterostomy) $853.81. The patient is morbidly obese with a Body Mass Index of 45 and the operating surgeon has indicated this in a note record on the claim submission or in a letter. Fee item 70019 is payable. Hint: When a Certified Surgical Assist is requested due to morbid obesity, the patient’s BMI must be provided for independent consideration.

For neurosurgeons assisting with 03222, bill T70019/20.

Additional neurosurgeons involved in the surgery 03222 as assistants should claim the certified surgical assistant’s fees. Other surgical specialists required because of their specific expertise should claim separately in accordance with Clause D. 5. 3. of the Preamble to the Payment Schedule. 03222 – Craniotomy lasting more than 12 hours and requiring operating microscope – $5,235.00. Notes: i) 03222 is applicable to the principal neurosurgeon who is required to spend more than 12 hours performing this surgery.

1.2 Cardiovascular Surgical Assist Codes

For assisting cardiovascular diagnostic and therapeutic procedures, bill codes 00845/6.

Cardiology Assist Fees: 00845  – For first hour or fraction thereof – $108.90.
Cardiology Assist Fees after one hour: 00846  – For each 15 minutes or fraction thereof – $27.23.
If a Cardiology assist is required with C33076, may bill Cardiology Assist Fee Items 00845 (first hour or fraction thereof) and 00846 (after one hour, each 15 minutes or fraction thereof) @50%. C33076 – Percutaneous balloon valvuloplasty for aortic stenosis (composite fee) – $600.00. Notes: i) Includes all necessary catheterizations, angiography (00801, 00810, 00812, 00827, 00871, 00888, 00889, 33030), angiocardiography, intraarterial cannulation, right heart catheterization, retrograde left heart catheterization, pulse tracing (intravascular), temporary pacemaker, any medically necessary diagnostic imaging (e.g.: Intra-cardiac ultrasound), CVP, arterial lines, blood pressure measurements, and any pharmacological infusion and studies, blood sampling, blood analysis and interpretations done in association with procedure. ii) 30 days pre and 48 hour post-operative visits in hospital included. iii) 00840 (percutaneous trans-luminal coronary angioplasty) and 00841 (direct coronary angiography) may be billed at 50% if done with this Procedure.
Cardiologist (specialty 26) is paid under 00845/6 when assisting 33071. 33071 – Percutaneous endovascular Aortic or Pulmonary Heart Valve Replacement – $1,125.00. Notes: i) All diagnostic imaging, all necessary left and right heart catheterizations, arterial or venous cannulation, blood sampling, CVP, pressure or gradient measurements, infusion of pharmacological agents, temporary pacing and pacemaker, and percutaneous balloon valvuloplasty are included. ii) 30 days pre and 48 hour post operative in hospital visits included iii) Cardiac Surgeon (specialty 12) paid under 07917/07920 when assisting for 33071.
Medically necessary assistance with 50550 is payable under cardiac assist fee items 00845 and 00846. 50550 – Percutaneous cardiac stenting in pediatric patients (0 – 18 years of age) – composite fee (operation only) – $1,013.32. Notes: i) Applicable to placement of stents in vena cava, pulmonary or coronary arteries and veins and aorta. ii) Includes all necessary diagnostic imaging, right and left heart catheterization,all necessary angiograms and/or angioplasty, coronary or elsewhere and stent implantation to include any declotting or treatment of underlying cause of access failure. iii) Not payable with fee items 00898 and 00871. This composite also includes the taking of blood pressure (intra-arterial or intravenous), calculation of pressure gradients during the procedure and any pharmacological study or infusion of therapeutic substance. iv) Payable to Pediatricians only.
Medically necessary assistance payable under cardiac assist fee items 0845 and 00846. 50555 – Percutaneous transcatheter cardiac occluder device closure of ASD in pediatric patients (0 – 18 years of age) – composite fee (operation only) – $1,013.32. Notes: i) Includes all necessary diagnostic imaging, right and left heart catheterization, all necessary angiograms and/or angioplasty, coronary or Medical Services Commission – December 1, 2015 28-8 elsewhere and stent implementation to include any declotting or treatment of underlying cause of access failure. ii) Not payable with fee item 00871. This composite fee also includes the taking of blood pressure (intra-arterial or intravenous), calculation of pressure gradients during the procedure and any pharmacological study or infusion of therapeutic substance. iii) Payable to Pediatricians only. Example. Fee item 50555 (percutaneous transcatheter cardiac occluder device closure of ASD in pediatric patients (0-18yr) – composite fee) is performed, the surgical assistant time is from 0800hrs. to 1100hrs. Payment would be:
  • From 0800hrs. to 0900hrs., 1 x fee item 00845 (cardiology assist for first hour or fraction thereof).
  • From 0900hrs. to 1100hrs., 8 x fee item 00846 (after one hour, for each 15 minutes or fraction thereof).

1.3. Open heart surgery assist codes

For open heart surgery for 1st assistant, bill 07915, 07917, 07920.

Open heart surgery: 07915 – First assistant for operations of $1,033.00, or less -$270.52
Open heart surgery: 07917 –  First assistant for operations over $1,033.00 – $388.13.
Open heart surgery: 07920 – Time, after four hours of continuous surgical assistance for one patient
  • each 15 minute period or fraction thereof – $21.24.
Cardiac Surgeon (specialty 12) paid under 07917/07920 when assisting for 33071. 33071 – Percutaneous endovascular Aortic or Pulmonary Heart Valve Replacement – $1,125.00 Notes: i) All diagnostic imaging, all necessary left and right heart catheterizations, arterial or venous cannulation, blood sampling, CVP, pressure or gradient measurements, infusion of pharmacological agents, temporary pacing and pacemaker, and percutaneous balloon valvuloplasty are included. ii) 30 days pre and 48 hour post operative in hospital visits included. iii) Cardiologist (specialty 26) paid under 00845/6 when assisting 33071.
Example 1. Fee item 07868 (atrial septum defect, patch – $1394.63) is performed. The surgical assistant time is from 0800hrs. to 1230hrs., payment would be:
  • From 0800hrs. to 1200hrs., 1 x fee item 07917 (first assistant for operations over $1033.00).
  • From 1200hrs. to 1230hrs., 2 x fee item 07920 (time, after 4 hours of continuous surgical assistance for one patient, each 15 minute period or fraction thereof).
Example 2.  Fee item 07859 (aortic valve replacement – $1,556.00) is performed and 2 assistants were medically required in this case, the surgical assistant time is from 0800hrs. to 1215hrs. Payment would be as follows. For a specially qualified first assistant
  • From 0800hrs. to 1200hrs., 1 x fee item 07917 (first assistant for operations over $1,033.00).
  • From 1200hrs. to 1215hrs., 1 x fee item 07920 (time, after four hours of continuous surgical assistance for one patient, each 15 minute period or fraction thereof).
For a non-CVT – certified assistant
  • 17 x fee item 00193 (Open Heart Surgery – Non-CVT-certified surgical assistance at open-heart surgery, per quarter hour or major portion thereof)
  • Note: The same fee applies equally to all assistants (first, second, etc.).
A multiple valve replacement (fee item 07864 at $2,348.92) is performed and only 1 assist is required in this case, the surgical assistant time is from 0800hrs to1215hrs. Which of the following is the applicable billing? (a) For a specially qualified assistant: 1 x fee items 07917 (first assistant for operations over $1033.00) and 1 x fee item 07920 (time, after 4 hours of continuous surgical assistance for one patient, each 15 minute period or fraction thereof). For a non-CVT certified surgical assist: 17 x fee item 00193 (Non-CVT-certified surgical assistance at open-heart surgery, per quarter hour or major portion thereof) (b) 1 x fee item 70019 (Certified Surgical Assistant), 8 x fee item 70020 (time after one hour of continuous certified assistance for one patient) and 5 x fee item 00198 (time, after 3 hours of continuous surgical assistance for one patient, each 15 minutes or fraction thereof) (c) 1 x fee item 00845 (cardiologist assist for first hour or fraction thereof) and 13 x fee item 00846 (after one hour, for each 15 minutes or fraction thereof) Correct answer is “a”.

For open heart surgery for 2nd and 3rd assistants, bill 07916, 07918, 07920.

Open heart surgery: 07916 – Second and third assistant for operations of $1,033.00, or less – $158.21.
Open heart surgery: 07918 – Second and third assistant for operation over $1,033.00 – $242.77.
Open heart surgery: 07920 – Time, after four hours of continuous surgical assistance for one patient
  • each 15 minute period or fraction thereof – $21.24.

1.4. Obstetrics and gynecology surgical assist codes

For 1st assistant with G04705, G04707 or G04709, bill G04710, G04711 and G04712.

G04710  – Gynecological certified surgical assistant – for up to one hour – $255.49 . Notes: i) Paid only with G04705, G04707 or G04709. ii) Time is calculated at the earliest, from the time of physician/patient contact in the operating suite. iii) Restricted to Obstetrics and Gynecology specialists.
G04711 – Gynecological certified surgical assistant, time after one hour of continuous certified surgical assistance for one patient, up to and including 3 hours of continuous surgical assistance for one patient
  •  each 15 minutes or fraction thereof – $26.67.
Notes: i) Please indicate start and end time of service on claim. ii) Restricted to Obstetrics and Gynecology specialists.
G04712 – Gynecological surgical assistant (certified or second), time after 3 hours of continuous surgical assistance for one patient
  • each 15 minutes or fraction thereof – $ 27.89.
G04705 – Removal of trans-vaginal placed synthetic mesh where indicated, from anterior or posterior compartment, due to pain or complications – $494.49. Notes: i) Fee items 00704, 00705 are not paid in addition. ii) Claims for surgical assistance for G04705 are payable under G04710, G04711, G04712. iii) Paid at 50% when done with 04605 or 04408. iv) Restricted to Obstetrics and Gynecology specialists.
G04707 – Laparoscopic sacrocolpopexy, includes oophorectomy and/or salpingectomy – $775.56. Notes: i) Fee items 00704, 00705, 00815, 04001, 04003, 04041, 04042, 04408, 04605, 04232, 04233 or G04706 not paid in addition. ii) Fee items 04040 and 04047 payable in addition but the maximum payable under these items shall not exceed the value of fee item 04229. iii) Other items listed under laparoscopic operations are not payable in addition to this item. iv) In cases where conversion to open surgery is necessary, 04001 paid at 50%, plus the open procedure. v) G04708 will apply after 2 hours. vi) Claims for surgical assistance for G04707 are payable under G04710, G04711, G04712. vii) Restricted to Obstetrics and Gynecology specialists.
G04709 – Laparoscopic total or supracervical hysterectomy, and/or laparoscopic assisted vaginal hysterectomy (LAVH) (includes oophorectomy and/or salpingectomy) – $860.36. Notes: i) Fee items 00815, 04001, 04003, 04041, 04042, 04048, 04202, 04228, 04229, 04232 and 04233 are not paid in addition. ii) Fee items 04043, 04044, 04047, 04660, and 04662 are payable in addition, but the maximum payable under these items shall not exceed the value of fee item 04229. iii) Other items listed under laparoscopic operations are not payable in addition to this item. iv) Claims for surgical assist are payable under fee items G04710, G04711, G04712, G04713. v) In cases where conversion to open surgery is necessary, 04001 paid at 50%, plus open procedure. vi) G04708 will apply after 2 hours. vii) Restricted to Obstetrics and Gynecology specialists.
Example. Fee item G04709 (laparoscopic total or supracervical hysterectomy, and/or laparoscopic assisted vaginal hysterectomy (LAVH) – includes oophorectomy and/or salpingectomy) is performed, the surgical assistant time is from 0800hrs to 1215hrs and two certified assists are required. For the first certified assistant payment would be:
  • From 0800hrs. to 0900hrs., 1 x fee item G04710 (gynecological certified surgical assistant-for up to one hour).
  • From 0900hrs. to 1100hrs., 8 x fee item G04711 (gynecological certified surgical assistant, time after one hour of continuous certified surgical assistance for one patient, up to and including 3 hours of continuous time – each 15 minutes or fraction thereof).
  • From 1100hrs. to 1215hrs., 5 x fee item G04712 (gynecological certified surgical assistant (certified or second), time after 3 hours of continuous surgical assistance for one patient, each 15 minutes or fraction thereof).

For 2nd assistant with with  G04709, bill G04713/2.

G04713 – Laparoscopic hysterectomy second surgical assistant – $243.78. Note: i) Paid only with G04709.
G04712 – Gynecological surgical assistant (certified or second), time after 3 hours of continuous surgical assistance for one patient
  • each 15 minutes or fraction thereof – $ 27.89.
Example. Fee item G04709 (laparoscopic total or supracervical hysterectomy, and/or laparoscopic assisted vaginal hysterectomy (LAVH) – includes oophorectomy and/or salpingectomy) is performed, the surgical assistant time is from 0800hrs to 1215hrs and two certified assists are required. For the second certified assistant payment would be:
  • From 0800hrs. to 1100hrs., 1 x fee item G04713 (laparoscopic hysterectomy second surgical assistant – paid only with G04709).
  • From 1100hrs. to 1215hrs., 5 x fee item G04712 (gynecological certified surgical assistant (certified or second), time after 3 hours of continuous surgical assistance for one patient, each 15 minutes or fraction thereof).

1.5. General surgical assists

If none of the above applies, bill general surgical assistant fees 00195, 00196, 00197, 00198.

For the first THREE hours or fraction thereof, bill ONE of the following codes for EACH eligible procedure during one assist.

If the total operative fee(s) for procedure is less than than $317.00 inclusive, bill
  • 00195 – $131.64
Example: Surgical fee(s) paid to the surgeon:  fee item V07475 (partial Axillary dissection)  – $232.77. Code billable for surgical assistance – fee item 00195.
If the total operative fee(s) for procedure ranges from $317.01 to 529.00 inclusive, bill
  • 00196 – $185.59
Example: Surgical fee(s) paid to the surgeon:  Fee item V07472 (total Mastectomy) –  $465.01. Code billable for surgical assistance – fee item 00196.
If the total operative fee(s) for procedure is over $529.00, bill
  • 00197 – $245.47
Example 1: Surgical fee(s) paid to the surgeon:
  • Fee items V07472 (100%-$465.01) and
  • V07475 (50%-$116.39).
The total of the two surgical fees equal $581.40. Code billable for surgical assistance – fee item 00197. Example 2: Fee item 03161 (posterior laminectomy for localized spinal stenosis, two levels or less – $773.94) is performed.  The surgical assistant time is from 0800 to 1100. Only 1 x fee item 00197 is payable.
Fee items 00195, 00196 and 00197 are billable by all specialties that have the qualifications to assist at surgical procedures. Payment is based on the value of the total operative fee(s) that is paid to the operating surgeon. If billing T70019/20 for procedures without prefix “C” without providing a detailed report necessitating the services of a certified surgical assistant, codes T70019/20 could be reduced to a surgical assist fee (fee items 00195, 00196, or 00197).

After THREE hours of continuous surgical assistance for one patient, add code 00198.

00198 –  Time, after 3 hours of continuous surgical assistance for one patient, each 15 minutes or fraction thereof $27.80.
Fee item 03161 (posterior laminectomy for localized spinal stenosis, two levels or less -$773.94) is performed. The surgical assistant time is from 0800 to 1135 hrs., payment would be:
  • From 0800 to 1100, 1 x fee item 00197 (surgical assistance at surgery/surgeries over $529.00).
  • From 1100 to 1135, 3 x fee item 00198 (time, after 3 hours of continuous surgical assistance for one patient, each 15 minutes or fraction thereof).

If assisting with 78041 (Laser Lead Extraction), bill 00197.

Claims for surgical assistance for laser lead extraction are payable under 00197. 78041  – Laser Lead Extraction after 30 days, first lead – $1,382.72 9 Notes: i) Not payable with 07845, 33030, and 33057. ii) Includes any and all diagnostic imaging related to the surgery.

If billing 14108/9, bill surgical assists extra.

Surgical assistant is extra to fee items 14108. 14108 – Post-natal care after elective caesarean section (1-14 days in-hospital) – $115.31. Note: When medically necessary additional post-partum office visit(s) are payable under fee item P14094.
Surgical assistant is extra to fee item 14109. 14109 – Primary management of labour and attendance at delivery and post-natal care associated with emergency caesarean section (1 – 14 days inhospital) – $466.87 Notes: i) When medically necessary additional post-partum office visit(s) are payable under fee item P14094.

1.6. Billing Rules for Surgical assists

If none of the above applies, bill general surgical assistant fees 00195, 00196, 00197, 00198.

When to bill for surgical assists

In those rare situations where an assistant is required for minor surgery a detailed explanation of need must accompany the account to the Plan.
Where a medical practitioner renders surgical assistance at two operations under the same anesthetic but for which repositioning or redraping of the patient or more than one separately draped surgical operating field is medically/surgically required, separate assistants’ fees may be claimed for each operation, except for bilateral procedures, procedures within the same body cavity, or procedures on the same limb. –  MSC Payment Schedule Index, D. 5.4. (ii). Example 1. The operations performed are:
  • Fee item V70479 (radical mastectomy) $762.62
  • Fee item 06018 (removal of tumour, including intraoral – more than 10 cm) $443.84.
*Information provided is that fee item 06018 is performed on the back and the tumour size is 12 cm*. In accordance with Preamble D. 5. 3. ii., fee items V70479 at 100% ($762.62) and 06018 at 75% ($332.88) are payable to the surgeon. If assistance is required at both procedures,
  • 1 x fee item 00197 is payable for the procedure on the breast and
  • 1 x fee item 00196 is payable for the procedure on the back, as the second procedure would require a separate incision , repositioning and re-draping.
Example 2. The operations performed are bilateral mastectomies:
  • Fee item 2 x V07472 (total, for malignancy) $465.01
  • In accordance with Preamble D. 5. 3. i., 2 x fee item V07472 is payable at 150% ($697.52) to the surgeon.
Only 1 x fee item 00197 is payable to the surgical assistant as this is a bilateral procedure. Example 3. The operations performed are:
  • Fee item V07636 (resection of small intestine) $591.73
  • Fee item V07627 (gastrojejunostomy) $425.82.
  • In accordance with Preamble D. 5. 3. i., fee items V07636 at 100% ($591.73) and 07627 at 50% ($292.91) are payable to the surgeon.
Only 1 x fee item 00197 is payable as the procedures performed are in the same body cavity. Example 4. The operations performed are on the left arm:
  • Fee item 52735 (O.R.I.F – two parts of the proximal humerus) – $531.06.
  • Fee item 53765 (O.R.I.F. of the radius and ulna shaft) – $531.06.
  • In accordance with Preamble D. 6. a., fee items 52735 and 53765 are both payable at 100% to the surgeon.
Only 1 x fee item 00197 is payable as the surgery is performed on the same limb. Quiz. A mastectomy (1 x fee item V07498 at 100% – $555.74) and an anoplasty (1 x fee item V70665 at 75% – $332.10) are performed. Which of the following is the applicable billing? (a) 2 x fee item 00197 (assistance at surgery over $529.00) (b) 2 x fee item 00196 (assistance at surgery $317.01 to 529.00 inclusive) (c) 1 x fee item 00197 (assistance at surgery over $529.00) for the mastectomy and 1 x fee item 00196 (assistance at surgery $317.01 to 529.00 inclusive) for the anoplasty as the second procedure is in a different body cavity and would require re-draping and a separate incision. The correct answer is (c). 1 x fee item 00197 (assistance at surgery over $529.00) for the mastectomy and 1 x fee item 00196 (assistance at surgery $317.01 to 529.00 inclusive) for the anoplasty as the second procedure is in a different body cavity and would require re-draping and a separate incision.
Where surgery is abandoned, independent consideration will be given to the fee applicable to the assistant, to a maximum of 50 percent of the listed assistant fee for the intended procedure. –  MSC Payment Schedule Index, D. 5.4. (v). Example: The patient was undergoing a hysterectomy operation (fee item 04228 at $569.80) and had a myocardial infarction necessitating resuscitation. The surgery was abandoned due to the patient’s poor health. A percentage of fee item 00197 would be paid based on the information provided. Hint: An operative report should be submitted to facilitate payment.
When two procedures are performed under the same anesthetic by two surgeons and both procedures are or should be within the competence of either one of the operators within the specialty or specialities, the total surgical fee claimed should be no more than that which would be payable if both procedures had been performed by one surgeon, plus one assistant’s fee. – MSC Payment Schedule Index, D.5.3.(iv).

When to bill patient directly

If you assisted at the procedure whose billing code starts with letter “S”, a surgical assistant fee is not payable for that procedure. –  MSC Payment Schedule Index, B. Prefixes to fee codes. Quiz. A percutaneous nephrostomy (fee item S00978 at $288.93) is performed. Which of the following is the applicable billing? (a) Fee item 00195 (assistance at surgery less than $317.00 inclusive) (b) Fee item 00845 (cardiologist assist for first hour or fraction thereof) (c) Assist fees are not payable as the procedure is prefixed with the letter “S” The correct answer is C. In accordance with Preamble B., Prefixes to Fee Codes, Assist fees are not payable as the procedure is prefixed with the letter “S”.
Services requested or required by a “third party” for other than medical requirements are not insured under MSP. Services such as consultations, laboratory investigations, anesthesiology, surgical assistance, etc., rendered solely in association with other services which are not benefits also are not considered benefits under MSP, except in special circumstances as approved by the Medical Services Commission (e.g.: Dental Anesthesia Policy). – MSC Payment Schedule Index, C.1.
Authorization from MSP is required for those categories of procedures for alteration of appearance  for which some cases may not be a benefit under MSP policy. Where authorization has been denied or has not been obtained when required for a surgical procedure, the associated consultations, anesthesiology and surgical assistance also are not covered by MSP. Hospitalization costs also will remain the patient’s responsibility. – MSC Payment Schedule Index, D.9.1.
Medical Practitioner Services Excluded under the Inter-Provincial Agreements for the Reciprocal Processing of Out-of-Province Medical Claims: 1. Surgery for alteration of appearance (cosmetic surgery) 2. Gender-reassignment surgery 3. Surgery for reversal of sterilization 4. Routine periodic health examinations including routine eye examinations (including PAP tests for screening only) 5. In-vitro fertilization, artificial insemination 6. Acupuncture, acupressure, transcutaneous electro-nerve stimulation (TENS), moxibustion, biofeedback, hypnotherapy 7. Services to persons covered by other agencies; Armed Forces, WorkSafe BC, Department of Veterans Affairs, Correctional Services of Canada (Federal Penitentiaries) 8. Services requested by a “Third Party” 9. Team conference(s) 10. Genetic screening and other genetic investigation, including DNA probes 11. Procedures still in the experimental/developmental phase 12. Anesthetic services and surgical assistant services associated with all of the foregoing. The services on this list may or may not be reimbursed by the home province. The patient should make enquires of that home province after direct payment to the BC medical practitioner. – MSC Payment Schedule Index, C. 11.
If MSP has not approved funding for the gender-reassignment surgery, any medical consultation(s), anesthesiology and surgical assistance services related to the surgery, will not be eligible for MSP funding. – MSC Payment Schedule Index, D.9.4.

How to calculate time of the surgical assist

Time, for the purposes of fee codes 00193, 00195, 00196, 00197, 00198, 07920, T70019 and T70020 is calculated at the earliest from the when the medical surgical assistant makes contact with the patient in the operating suite. The end time is defined as when the assistant leaves the operating suite. – MSC Payment Schedule Index, D. 5.4. (i).

When to bill visit fees on the day of surgical assistance.

Visit fees are not payable with surgical assistance listings on the same day, unless each service is performed at a distinct/separate time. In these instances, each claim must state time service was rendered.   Quiz. A physician was called to assist at an open reduction of the hip (fee item 55725 at $700.47) and arrived at the hospital at 1600hrs. Which of the following is the applicable billing? (a) Fee items 13200 (out of office visit, age 2-49) and 00197 (assistance at surgery over $529.00). (b) Fee item 00197 (assistance at surgery over $529.00) only. Visit fees are not payable in addition. (c) Fee item 00112 (emergency visit) and 00197 (assistance at surgery over $529.00). The correct answer is (b). Fee item 00197 (assistance at surgery over $529.00) only. Visit fees are not payable in addition.
If, in the interest of the patient, the referring medical practitioner is requested by the patient or the surgeon to attend but does not assist at the procedure, attendance at surgery may be claimed as a subsequent hospital visit. –  MSC Payment Schedule Index, D. 5.4. (iii).

1.7. Codes incompatible with surgical assists

If you are billing surgical assists, do not bill codes P56322, V70650/1, PV70660/1.

P56322/3 is not paid to Orthopaedic Surgeon performing a surgical assist. P56322 – Abrasion debridement, one or more compartments must include substantial debridement of pathologic articular cartilage and includes synovectomy, meniscal trimming and/or chondroplasty, extra – first 15 minutes, or major portion thereof – $141.04. Notes: i) Paid only with knee arthroscopy (56305, 56306, 56310, 56315, 56320, 56325 and 56335). ii) Start and end times of debridement must be recorded in the patient’s chart and claim submission. P56323 – Abrasion/debridement, extra – each additional 15 minutes, or major portion thereof – $70.52 Notes: i) Paid only with P56322. ii) Paid to a maximum of two additional units. iii) Start and end times of debridement must be recorded in the patient’s chart and claim submission.
V700650/1 are not payable to same general surgeon doing the surgical assist. V70650 – Lysis of intra-abdominal adhesions, first 30 minutes (extra) – $150.00. V70651 – each additional 15 minutes or greater portion thereof (extra) – $75.00. Notes: i) Restricted to General Surgeons only. ii) Payable for open procedures only. iii) Not payable with fee item 07650. iv) Start and stop times for Lysis must be provided in patient chart and claim time field.
PV70660/1 are not payable to same general surgeon doing the surgical assist. PV70660 –  Lysis of intra-abdominal adhesions, laparoscopic – first 30 minutes (extra) – $150.00. PV70661 – each additional 15 minutes or greater portion thereof (extra) – $75.00. Notes: i) Restricted to General Surgeons only. ii) Not payable with fee item V07650, V70650 or S04001. iii) Start and stop times for laparoscopic lysis must be provided in patient chart and claim time field. iv) If conversion to open procedure is necessary, bill open procedure plus 50% of laparoscopy fee, 04001.

If you are billing 07700/2 or 07571/93, do not bill surgical assists.

When 07700 and 07702 are claimed, assistants’ fees are not applicable to either surgeon for assisting the other. V07700 – Total correction cloacal anomalies; primary surgeon – $2,109.12. 07702 – Fee for second surgeon participating in total correction of cloacal anamolies – $386.68.
When 07571 and 07593 are claimed, assistants’ fees are not applicable to either surgeon for assisting the other. V07571 – Pena posterior sagittal anal proctoplasty; primary surgeon – $1,127.98. 07593 – Fee for second surgeon participating in Pena posterior sagittal anal proctoplasty – $332.60.

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Step 2. Add First Surgical Assist of the Day Charge

Some specialists can bill additional charge for first surgical assist of the day charge.

51194 – First Surgical Assist of the Day – Orthopaedics – $75.24. Notes: i) Restricted to Orthopaedic Surgeons. ii) Maximum of one per day per physician, payable in addition to 00195,00196, 00197.
81194 – First Surgical Assist of the Day – Urology – $75.00. Notes: i) Restricted to Urology Surgeons. ii) Maximum of one per day per physician, payable in addition to 00195, 00196, 00197.
Do not bill 13194 for surgical assistance performed by specialists. This code is payable to general practitioners only.

Step 3. Add Out-Of-Office Hours Premiums

The out-of-office premium is an additional fee that may be billed for services initiated and rendered within designated time limits. These premiums are applicable to eligible insured medical services provided to MSP beneficiaries and can be billed by both General Practitioners and Specialists. The out-of-office premiums include Call-Out charges and Continuing Care surcharges.

Add ONE code from EACH category, if applicable.

Bill in addition to  procedure ONE of the following, if applicable. Call-Out charges:
  • 01200  – Evening (call placed between 1800 hours and 2300 hours and service rendered between 1800 hours and 0800 hours) – $59.34;
  • 01201 – Night (call placed and service rendered between 2300 hours and 0800 hours)- $83.35;
  • 01202 – Saturday, Sunday or Statutory Holiday (call placed between 0800 hours and 2300 hours) – $59.34.
Bill in addition to surgical assistance code(s) ONE of the following, if applicable. – MSC Payment Schedule Index, Section 2(e). Continuing care charges:
  • 01210 – Evening (1800 hours to 2300 hours) – 37.78% of surgical (or assistant) fee
    • minimum charge $53.38
    • maximum charge $368.28
  • 01211 – Night (2300 hours to 0800 hours) –  60.57% of surgical (or assistant) fee
    • minimum charge – $74.98
    • maximum charge – $517.16
  • 01212 – Saturday, Sunday or Statutory Holiday (Service rendered between 0800 hours and 2300 hours.)  – 37.78% of surgical (or assistant) fee
    • minimum charge – $53.38
    • maximum charge – $368.28
Notes: i) Codes 01210, 01211 must have  a “start time” in the “start time” field of your submissions to be accepted by the system.

When to bill out-of-office hours premiums

Out-of-office premiums are not applicable to full or part-time emergency physicians, or physicians designated by a hospital emergency room as the on duty/on site physician. Those physicians are referred to the Emergency Medicine Section of the Payment Schedule.
The out-of-office hours premium listings apply only to those services initiated and rendered within the designated time limits. They apply to visits to a physician’s office only if the office is officially closed during the designated time period.

When to apply call-out charges

Call-out charges apply only when the physician is specially called to render emergency or non-elective services to a patient at a different geographical location during out-of-office hours and only when the physician must travel from one location to another to attend the patient(s). It is charged extra to the consultation or other visit, or extra to the procedure if no consultation or other visit charged.
The call must originate in the designated time frame and the service must be rendered in the designated time frame (i.e., 1800-0800 hours, weekends, and statutory holidays). Claims must state time service rendered. Codes 01200, 01201 must have a “start time” in the “start time” field of your submissions to be accepted by the system.
The call-out charge (fee item 01200, 01201, 01202) applies only to the first patient examined or treated on any one special visit (not day).  Additional patients seen during the same call-out may be eligible for the continuing care surcharges.
A call-out charge is applicable to each special call-out whether or not a previous call-out charge has been billed for the same patient on the same day. For example, a physician may provide a consultation during out-of-office hours for which a callout charge is applicable. The physician may then perform an operation on the same patient at a different time during out-of-office hours. If the physician was specially called, on separate occasions, to render both services and was required to travel from one location to another for both services, it would be appropriate to bill a call-out charge for the consultation and a call-out charge for the operation in addition to the regular fees for the services and any applicable continuing care operative and non-operative surcharges.
Fee item 01202 is not applicable for routine care provided on the weekend. This is a call-out fee, and all criteria in the Out-of-Office Hours Premiums section of the Payment Schedule must be met in order to bill this fee.

When to bill continuing care charges

OPERATIVE continuing care surcharges are applicable only to emergency surgery or to elective surgery which, because of intervening emergency surgery, commences within the designated times. 
To be billed in addition to surgical fees or surgical assistant fees for emergency surgical services provided outside regular office hours (i.e. 1800 – 0800 hours, weekends, and statutory holidays).
Applicable only to surgical procedure(s) requiring general, spinal or epidural anesthesiology and/or requiring at least 45 minutes of surgical time.
The following applies in the event that a consultation or visit is followed by surgery:
  1. the non-operative continuing care surcharge applies to the consultation or visit, and
  2. the operative continuing care surcharge applies to the surgery.
When emergency surgery commences prior to 1800, even if the major portion of surgical time is after 1800, surgical surcharges are not applicable.

How to determine time for continuing care charges

When surgery commences within evening time period (1800 – 2300 hrs) and continues into night time period (2300 – 0800 hrs), the appropriate item for billing is determined by the period in which the major portion of the surgical time is spent.
If emergency surgery commences prior to 0800 and continues after 0800, surcharges are applicable to the entire surgical time.
Save time by skipping ``Referred by`` section
Surgical assistants do not need to fill in the “Referred by” section of the claim with the practitioner number of the surgeon. MSP finds the surgeon by the patient’s personal health number and the date of service in your claim.
Surgical Assistant's Check List - for Specialists
1. How many operations were performed under the same anesthetic that qualify for independent billing of surgical assistant fees?
  • You might be able bill for multiple assists.
2. What is the billing code of the procedure(s)?
  • If a procedure starts with “S”, you will not be paid for the assist.
3. What are the total fees of each procedure payable to the surgeon?
  • Your billing code depends on it.
4. Was it a minor procedure?
  • Ask the surgeon to submit a note justifying your assistance at the minor procedure. Otherwise, you will not be paid.
5. Did the procedure start with prefix “C”?
  • You might be able to bill certified surgical assistant charges.
6. Did the procedure have unusual technical difficulties?
  • Ask the surgeon to submit a report, so that you can bill certified surgical assistant charges.
7. Was it your first surgical assist of the day?
  • You might qualify for 1st surgical assist of the day charges.
8. What was the earliest time when you made a contact with the patient in the operating suite?
  • That was the start of your assistance. Your continuing care charge and charge for the assistance over three hours depend on it. You must report the start time on your claims.
9. When did you leave the operating suite?
  • Your might be eligible to bill a higher rated continuing care charge code if the major part of the procedure went past 11 pm. In addition, your charge for the assistance over three hours depends on it. You are expected to report the end time on your claims.
10. When did you receive the call to assist?
  • Your call-out charge depends on it. You must report it on your claims if billing call-out charges.
11. Was it out-of-province patient?
  • Certain procedures for reciprocal patients are not eligible for surgical assists.
12. Was the surgery abandoned?
  • Make sure to claim it. You still might be paid up to 50% of the fees. Ask the surgeon to submit a report.

Surgical Asssistance Payments by MSP Codes

T70019 - CERTIFIED SURGICAL ASSIST
$1.4M
T0020 - CERTIFIED SURGICAL ASSIST 1-3 HRS
$0.8M

BC, 2014/2015

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Disclaimer
The information contained herein has been drawn from sources known to be reliable, but the accuracy and/or completeness of the information is not guranteed, nor in providing it does TripleTee Software Company assume any responsibility or liability.