I work for an orthopedic surgeon who does predominantly worker’s compensation billing. Recently, we have gotten denials from some of the insurance carriers denying the assistant surgery due to "the surgeon must specify what specifically the assistant performed." We have never heard of this requirement, and the surgeries are always authorized for an assist. Additionally, these are codes that have the correct Medicare indicator to receive payment for an assist. I found a blog article from 2013 written by Marilyn Holley, CPC, CPC-I, RHIT, CHISP, (https://www.aapc.com/blog/25432-prom…rgery-payment/) that contained a sentence stating the physician must include these details in their report as well, however, she did not cite the guideline that would require specifics in the documentation of what the assistant did. Due to our recent denials, I was hoping for some help…Is there a requirement for the assistant’s actions to be specifically documented in the report? If so, what is the regulation and where is this stated?

Thank you in advance for the input!