Actively Assisting PA

Question:

What are the documentation requirements for a teaching physician when both a resident surgeon and a PA first assist are present in the operating room? The PA is actively assisting, and both individuals are noted in the operative report.

Answer:

In a teaching facility, if a resident acts as assistant and if that resident is considered (by the teaching physician) to be qualified to assist in the case, no third provider will be reimbursed as an additional assistant. If, however, the teaching physician attests that no qualified resident was available to act as an assistant, a PA may be billed as assistant. The resident may still be present for teaching purposes and listed as participating in the case.

The definition of “qualified resident“ is case specific. It may be that a resident is not physically available or that the available resident is considered (by the teaching physician) to not be clinically qualified for the specific operative case. A teaching facility’s compliance department may have specific language for an attestation statement.

*This response is based on the best information available as of 12/18/25.