In collaboration with 15 specialty surgical organizations, the American College of Surgeons (ACS) has published and released its seventh edition of Physicians as Assistants at Surgery. The report is meant to provide guidance to CMS and third-party payors on how often an operation might require the use of a physician as an assistant.

According to the ACS, a physician as an assistant during an operation should be a trained individual who can participate in and actively assist surgeons in completing surgeries safely. However, when surgeons are not available to serve as assistants, a qualified surgical resident or other qualified healthcare professional—such as a nurse or physician’s assistant with experience in assisting a procedure—can be used.

The Update

To update the report, each participating organization reviewed the 2012 and 2013 American Medical Association (AMA) Current Procedural Terminology (CPT) codes that were applicable to their specialty and classified by the CPT as “surgery.” The result was the addition of 107 new codes to the report, as well as the revision of 74 previously included codes.

“CMS asks the specialty societies to make comments as to whether the surgical procedures for which the codes are assigned are appropriate for a physician assistant,” says Mark Savarise, MD, FACS, who served as ACS’s alternate advisor to the AMA CPT editorial panel. “In 2013, new codes came out for the use of skin substitutes, for instance, so those codes had to be reviewed.”


Dr. Savarise notes that a slight discrepancy exists between the ACS and CMS. “The ACS and surgical specialty societies keep lists for procedures that require physician assistants and classifies them as ‘almost always,’ ‘almost never,’ or ‘sometimes,’” he says. “CMS, on the other hand, has a ‘yes’ or ‘no’ list. For the ACS’s ‘sometimes’ codes, we had to decide if the associated procedures were more likely or unlikely to require an assistant and then decide on a ‘yes’ or ‘no.’”

The nearly 200-page updated report covers new CPT codes for the following procedures:

♦  Revision for total shoulder and elbow arthroplasty.

♦  Bronchoscopy.

♦  Thoracentesis.

♦  Transcatheter aortic valve replacement.

♦  Selective catheter placement.

♦  Transcatheter therapy.

♦  Esophagoscopy.

♦  Upper gastrointestinal endoscopy.

♦  Cystourethroscopy.

Using the Report

“Surgeons should make sure to reference the Physicians as Assistants at Surgery report when they serve as an assistant because there may be some procedures for which they won’t be able to get paid their assistant’s fee,” says Dr. Savarise. “Just like having access to the updated CPT code list, it’s important to have access to this report because it’s useful for billing and scheduling purposes.”