2 Providers repairing one laceration

SUEV

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When a doctor closes the deeper layers of a laceration and leaves the PA to close the surface layer, is it ok to bill under the doctor? I'm assuming it's because the PA doesn't have the experience in this walk-in facility but I'm not sure if we can bill for this since we're not a teaching facility. Any advice is greatly appreciated!
Thanks,
Sue
 
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When a doctor closes the deeper layers of a laceration and leaves the PA to close the surface layer, is it ok to bill under the doctor? I'm assuming it's because the PA doesn't have the experience in this walk-in facility but I'm not sure if we can bill for this since we're not a teaching facility. Any advice is greatly appreciated!
Thanks,
Sue

First, I'd check with the payer's policies to see if the service is payable for a PA, regardless of whether or not he/she did only a portion. (As well as good old Medicare's policies). Without more specifics, it's a bit tough for me since I can't personally read up on it.

BUT I do potentially have a comparison that may or may not apply to your particular circumstance or situation. I used to code for a burn unit and we had a PA who did the surgical prep and then a physician did the actual grafting (unassisted). So long as both the PA and the MD had separate op notes stating the portion each one did, including what the opposite person did in their notes, we billed the PA on one claim with the AS mods and then the MD on a separate claim (no mods because it was a separate procedure). Inevitably (and as expected), we'd always have to submit both op reports for each claim to allow for explanation of what portion each one did. We'd get 100% reimbursement for the MD and the usual 80% for the PA. However, they each did their own separately distinct portion of the surgery, not performing together on the same procedure even though it was the same site.

My question for you would be, why didn't the physician just finish it up him/herself? (Which is exactly what the payer will ask). If the PA was simply closing the surface layer JUST TO LEARN, then that poses a large problem because that's definitely NOT medically necessary. Also, was the MD present when the PA completed his/her portion? What codes are you planning to bill? Did both the MD and the PA write up their own separate procedure notes? I assume it was ONE laceration...
 
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