Surgical Assist

i) Time, for the purposes of fee codes 00193, 00195, 00196, 00197, 00198, 07920, T70019 and T70020 is calculated at the earliest from the when the medical surgical assistant makes contact with the patient in the operating suite. The end time is defined as when the assistant leaves the operating suite. 

ii) Where a medical practitioner renders surgical assistance at two operations under the same anesthetic but for which repositioning or redraping of the patient or more than one separately draped surgical operating field is medically/surgically required, separate assistants’ fees may be claimed for each operation, except for bilateral procedures, procedures within the same body cavity, or procedures on the same limb. 

iii) If, in the interest of the patient, the referring medical practitioner is requested by the patient or the surgeon to attend but does not assist at the procedure, attendance at surgery may be claimed as a subsequent hospital visit. 

iv) The specialist’s assistant listings apply only to surgical procedures having unusual technical difficulties identified and documented by the primary surgeon in a detailed note record as necessitating the services of a certified surgical assistant. The general assistant listings are applicable to all other situations where surgical assistance is necessary. (Also see Preamble B. Definitions, Prefixes to Fee Codes). 

v) Where surgery is abandoned, independent consideration will be given to the fee applicable to the assistant, to a maximum of 50 percent of the listed assistant fee for the intended procedure.

Cosmetic Surgery 

The guidelines for MSP coverage of surgery for alteration of appearance are listed under Preamble D. 9. For cosmetic surgery not covered by MSP, the anesthetic and assistants’ fees also are not covered. In addition, hospitalization charges are not insured for cosmetic surgical procedures not covered by MSP.

Fractures and Other Trauma 

a. When multiple procedures for multiple fractures and/or soft tissue injuries are done by the same surgeon, through different incisions, the largest fee should be charged at 100% and all subsequent fees at 75%. In cases of dissociated injuries for which the presence of one impedes the progress of another, or in the case of multiple major fractures (e.g.: a fractured femur and tibia in the same limb), a full fee for each (to a maximum of 3) may be charged provided that adequate clinical evidence to support this charge is rendered with the account.

 b. Open (compound) fractures: primary wound management fee(s) may be charged in addition to the fracture fee and will be paid at the same percentage as applies to the fracture fees. These wound management fee items are exempt from the 14 day rule (D.5.1). Secondary wound management fees may also be charged and are exempt from the 14 day rule (D.5.1). These primary and secondary Wound Management fees are only applicable where fee items have been designated in a section’s schedule of fees for specific open fractures or specified primary or secondary wound management of fractures.

 c. Open reduction of fracture or dislocation when necessary - 50% extra may be charged if a fee for open reduction is not listed. 

d. All casts and plaster-moulded splints may be charged in full in addition to the procedure and visit fees, except that cast or plaster-moulded splint applied at the time of the initial procedure. In cases where a cast or plaster-moulded splint application or alteration is the sole purpose of a visit, a visit fee is not chargeable. Fees for application of casts or plastermoulded splints are payable only when performed by the medical practitioner. 

e. Open reduction of old malunited fracture - may be billed at an additional 25% of the listed fee unless a specific fee item exists. f. External Skeletal Fixation with closed reduction - may be billed at an additional 25% of the listed fee unless a specific fee item exists.