Looking for MSP Billing software for surgical assistants? Get a special billing module just for that.
Simple MSP Billing for SA
Claim Manager SA is simple MSP billing software for surgical assistants who want to do their billing themselves.
General practitioners performing surgical assistance
1. Select surgical assist code
- 00195/6/7/8 – General assists
- 00193 – Open heart surgery
2. Add 1st assist of the day
- 13194 – 1st surgical assist of the day
3. Add out-of-office hours premiums
- 01200/1/2 – Call-out charges
- 01210/1/2 – Continuing care surcharges
1. Select Surgical Assistance Billing Code(s).
Surgical assist billing code depends on the total operative fee(s) for procedure(s) billed by the surgeon, except assisting at open-heart surgery.
For the first THREE hours or fraction thereof, bill ONE of the following codes for EACH eligible procedure during one assist.
- 00195 – $131.64
- 00196 – $185.59
- 00197 – $245.47
- Fee items V07472 (100%-$465.01) and
- V07475 (50%-$116.39).
After THREE hours of continuous surgical assistance for one patient, add code 00198.
- 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 at OPEN-HEART surgery, do not bill 00195, 00196, 00197 or 00198. Bill code 00193.
- 00193 – $28.39 per quarter hour or major portion thereof
When to bill for surgical assists
- Fee item V70479 (radical mastectomy) $762.62
- Fee item 06018 (removal of tumour, including intraoral – more than 10 cm) $443.84.
- 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.
- 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.
- 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.
- 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.
How to bill for abandoned surgeryTo bill for an abandoned surgery, general practitioners need to use the code 00199 – miscellaneous fee item for general practice. Enter 1 service unit and the amount of up to 50% of the surgical assist fee payable had the surgery gone through (eg. up to 50% of the fee items: 00195, 00196, 00197). Fax the operative report or the report about partial procedure to MSP to fax # 250-405-3591. Add a note into your claim explaining the situation and confirming that the report was sent.
When to bill patient directly
How to calculate time of the surgical assist
When to bill visit fees on the day of surgical assistance.
If billing 14108 and 14109
If assisting with 78041 (Laser Lead Extraction)
2. Add First Surgical Assist of the Day Charge
If it was your first surgical assist of the day, add code 13194.
- 13194 – $81.53
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.
- 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.
- 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
When to bill out-of-office hours premiums
When to apply call-out charges
When to bill continuing care charges
- the non-operative continuing care surcharge applies to the consultation or visit, and
- the operative continuing care surcharge applies to the surgery.
How to determine time for continuing care charges
Save time by skipping ``Referred by`` sectionSurgical 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 General Physicians1. 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.
- If a procedure starts with “S”, you will not be paid for the assist.
- Your billing code depends on it.
- 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.
- 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.
- Your call-out charge depends on it. You must report it on your claims if billing call-out charges.
- Certain procedures for reciprocal patients are not eligible for surgical assists.
- Make sure to claim it. You still might be paid up to 50% of the fees. Ask the surgeon to submit a report.
Surgical Assist Payments by MSP Codes
00193 - NON-CVT CERT. SURGICAL ASSIST @ OPEN HEART SURGERY
00195 - SURGICAL ASSIST - LESS THAN $317.00 INCLUSIVE
00196 - SURGICAL ASSIST $317.01 TO 529.00 INCLUSIVE
00197 - SURGICAL ASSISTANCE - OPERATIONS OVER $529.00