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advice on office visit

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sune626

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I work for a podiatry practice and recently ran into a situation that I disagree with. the doctor said she wants it coded a certain way even though we both know it is not correct.
Situation: patient comes and sees an MA for custom orthotic casting. Dr. was not present in office was actually doing a surgery off site. The MA also did an x-ray because the doctor wanted her to. a 99211 was originally billed amongst other codes, but she wants a 99213 billed instead stating an x-ray was done ans she interpeted it later even though she was not here for a face to face encounter with patient
Also important to note, the Dr. is close friends with the patient and states she talked to her after hours so she can charge the visit this way!
I just want to know if I am off base in disagreeing or other's opinions!
thanks in advance!
 
sune626 said:
I work for a podiatry practice and recently ran into a situation that I disagree with. the doctor said she wants it coded a certain way even though we both know it is not correct.
Situation: patient comes and sees an MA for custom orthotic casting. Dr. was not present in office was actually doing a surgery off site. The MA also did an x-ray because the doctor wanted her to. a 99211 was originally billed amongst other codes, but she wants a 99213 billed instead stating an x-ray was done ans she interpeted it later even though she was not here for a face to face encounter with patient
Also important to note, the Dr. is close friends with the patient and states she talked to her after hours so she can charge the visit this way!
I just want to know if I am off base in disagreeing or other's opinions!
thanks in advance!
Click to expand...

If you would say PA instead of MA, I would bill everything with no problems under PA's NPI (for Medicare, I have no idea how commercial would process this). But, as far as I know MA is not a qualified, certified or whatsoever other healthcare provider and can not see patients and bill for this. Even if patient would not be "new", MA can not see the patients. PA can bill with his/her own NPI or with MD's NPI (under MD's direct supervision).
 
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