23 Miss. Code. R. 203-4.2

Current through December 10, 2024

Rule 23-203-4.2 - Assistant Surgeon

A. Medicaid covers an assistant surgeon during major surgery, including all surgical cases performed under spinal or regional anesthesia if the nature of the surgery requires the assistance of a second physician or surgeon. Medicaid covers only one (1) assistant surgeon for any case.

B. Medicaid does not cover interns, residents, fellows, physician assistants, and nurses, including nurse practitioners, as an assistant surgeon.

C. Medicaid covers the services of an assistant surgeon when the following criteria are met:

1. The operation must be a covered surgical procedure, and

2. The operation must be of sufficient difficulty and complexity to require an assistant surgeon, and

3. The assistant surgeon must actively assist in the surgery.

a) Medicaid defines actively assist as the assistant surgeon must assist in the actual performance of the surgical procedure, and

b) The assistant surgeon, in the event the surgeon is unable to continue, must be able to complete the surgery.

D. Medicaid covers the assistant surgeon's services at sixteen percent (16%) of the surgical fee for that particular surgery.

E. The appropriate modifier in conjunction with the procedure code for services rendered is required to identify an assistant surgeon's services.

F. Medicaid does not cover an assistant surgeon in a teaching hospital which has a training program related to the medical specialty required for the surgical procedure and which has a qualified resident available, unless one (1) of the following circumstances exists:

1. The assistant surgeon certifies that his services were medically necessary and no qualified resident was available to perform the services. There may be some instances when no qualified residents are available to assist in surgery due to a number of factors that include, but are not limited to, involvement in other activities, complexity of the surgery, number of residents in the program, or other valid reasons.

2. Exceptional medical circumstances, including emergency, life-threatening situations such as multiple traumatic injuries requiring immediate treatment.

3. The primary surgeon has an across-the-board policy on never involving residents in the preoperative, operative, or postoperative cares of his/her patients.

23 Miss. Code. R. 203-4.2

Miss. Code Ann. § 43-13-121