Coding assistant-at-surgery services in a teaching hospital can be challenging, particularly when determining whether Medicare will reimburse the assistant. One of the most common misconceptions is assuming that an assistant surgeon is automatically paid whenever they participate in the procedure.

The General Rule

CMS generally does not pay for assistants at surgery in a teaching hospital because residents are expected to participate in surgical procedures as part of their training. 

However, CMS recognizes circumstances in which an assistant at surgery may be appropriate and payable. 

When an Exception Applies

Medicare may allow payment for an assistant at surgery in a teaching hospital when one of the following exceptions is met: 

• A qualified resident is unavailable. The operative report should clearly document that no qualified resident was available to assist.  
• The operating physician does not involve residents in patient care.  
• The procedure requires multiple physician specialties. For particularly complex procedures, a team of surgeons with different specialties may perform distinct portions of the operation.  

🔍 Audit Takeaway

When coding assistant-at-surgery services in a teaching hospital, don’t stop at documenting that an assistant participated. Ensure the medical record clearly supports the application of Medicare’s teaching hospital exception. Clear documentation of the applicable exception can help support compliant billing and reduce audit risk. 

Each Auditor Insight is inspired by trends our auditing team sees in practice or by industry developments with meaningful implications for coding, documentation, and compliance. Our goal is to help organizations stay informed, reduce risk, and code with confidence.

Reference: CMS Internet-Only Manual, Pub. 100-04, Chapter 12, §100.1.7