Wiki Billing for a PA

Create Wiki
M

mjsjeep

Contributor
Messages
21
Best answers
0
Hello coders....need your help!

We have a PA in our office now and I never really billed for one before.
Patient came into the office and he did a 10061 I&D.
How would we bill for the PA to get paid for his service because I am afraid if we use the AS modifier it will be denied.
Any help is appreciated!!

Thanks
MJ
 
AS is for "An "assistant at surgery" is a physician who actively assists the physician in charge of a case in performing a surgical procedure"

Unless he was actually the assistant to the primary physician, you wouldn't use this.

Our PA does JUST about everything our medical doctors do. As long as he is par with the insurance, you just bill it out normal with your PAs information (NPI and such).

We only have trouble with a few insurances that she can't participate with. BCBS Medicare HMO for example, they won't authorize anything our PA does since they list PAs as "service provider" and not Dermatologist for example. I can't explain it well...but it's frustrating. We don't have her see those patients.

This article is older, but it might help..
http://www.physicianspractice.com/blog/understanding-physician-assistant-reimbursement
 
Here is a summary of billing under a PA:

Use exactly the same codes and modifiers that you would for a doctor.

Some commercial carriers (including Humana and Cigna) want you to bill PA services under the doctor's NPI. Medicare and other commercial carriers (including Aetna, BCBS FL, and UHC) only allow you to bill under the doctor's NPI if you meet the "incident to" standards. (If you don't meet them, then you have to bill under the PA's NPI.)

"Incident to" standards require that that a doctor in the practice (not necessarily the billing doctor) has made the diagnosis and established the plan of care, and that the billing doctor be present in the office at the time of the visit.

Medicare will reduce your payment by 15% when you bill under the PA's NPI. Some of the commercial carriers also might do so, although in our case only Aetna does.

You can Google "CMS incident to" for more details.
 
My supervisor is referencing an article that states the PA must dictate their own OP note when assisting in surgery. She thinks that it is a new rule for 2015. However, the document she is referencing is regarding the modifier 80.
Here is the documentation:
"Q17. What type of documentation is needed to support an assistant surgeon?s claim (billed with modifier 80)?

A17. The assistant surgeon?s record is a document that is created and authenticated by the assistant surgeon and outlines the service provided, to what extent etc? It should be a separate document or entry from the surgeon?s record. There would be an expectation that the surgeon also include documentation to support that an assistant surgeon was involved in the procedure and to what extent in their own documentation."​
Our PA says she has never had to dictate her own OP note as Assistant at surgery.

Does anyone have any info or guidance on this?
 
breakdown: modifier 80 is used only by MD's or DO's. They would need to dictate their own op note. And PA's are to use the AS modifier. The provider that they are assisting must list the PA's name in the heading of the op report "ASsistant Surgeon: John Doe" and spell out exacltly what the PA did and why the PA's assistance was needed. Not all CPT's are reimbursed with the AS modifier. If the service does not require a PA's help, it won't be paid. Make sure
 
You must log in or register to reply here.
Top