Guide explains when to use docs to assist in surgery

The American College of Surgeons, in collaboration with the AUA and 14 other specialty surgical organizations, has jointly published and released the seventh edition of a report that provides guidance on how often an operation might require the use of a physician as an assistant.

This edition of Physicians as Assistants at Surgery reflects the most recent clinical practices and is often relied upon by the Centers for Medicare & Medicaid Services and third-party payers, the College said.

Using the Current Procedural Terminology codes from the 2012 and 2013 codebooks, each participating organization reviewed codes applicable to their specialty that are classified by CPT as “surgery.” Participants indicated if the operation requires the use of a physician as an assistant at surgery: almost always, almost never, or some of the time.

The newly released report adds 107 codes that were introduced by CPT since the last report was issued in 2011. In addition, the report revises 74 codes that had been previously included. Historically, the report is conducted approximately every other year. However, to more accurately reflect new and updated CPT codes and to help improve the quality of care for the surgical patient, the College said updates to Physicians as Assistants at Surgery now will be conducted annually and a full review of all surgical CPT codes will be released every 5 years.

“The frequency of updating the report is becoming increasingly important,” says Mark Savarise, MD, American College of Surgeons alternate adviser at the AMA CPT Editorial Panel. “Medicare and third-party payers are attracted to the report because it provides a comprehensive clinical review of surgical procedures to bring an informed opinion from surgeons in the field about the frequency with which a physician’s services as an assistant at surgery are needed.”

Urologic operations classified as “almost always” requiring a physician as an assistant include nephrectomy (CPT codes 50220, 50225, 50230, 50234, 50236, and 50240) and repair of enterocele, vaginal approach (57268). Extracorporeal shock wave lithotripsy (50590) falls in the “almost never” category, while cryosurgical ablation of the prostate (55873) falls in the “sometimes” category.

The College maintains that a physician as an assistant used during an operation should be a trained individual who can participate in and actively assist the surgeon in completing the operation safely. When a surgeon is not available to serve as an assistant, a qualified surgical resident or other qualified health care professional, such as a registered nurse or physician's assistant with experience in assisting during a procedure, may be used, according to the College’s position as published in its Statements on Principles.

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