herrera4
Guru
When a PA dictates an HnP and Dr. signs off on it Is this billable by Dr.? If he does confirm "reviewed and agreed with PA" Thanks for any help
-
If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten your username or password use our password reminder tool. To start viewing messages, select the forum that you want to visit from the selection below..
Wiki Billing p.a. Consults?
- Thread starter herrera4
- Start date
btadlock1
Guest
Negative for a consult. You can bill a regular E/M, but a consult requires certain elements to really be considered a consult:
1. A request for a doctor's opinion (i.e., a consultation), must be made by a qualified source (eg, another doctor, PA, social worker, etc. - there's a list in the CPT book under the guidelines on page 17)
2. The consulting doctor gives his opinion/advice, in a formal written report, back to the requesting source.
3. All of the above is documented in the patient's medical record.
As far as who to bill the (non-consultation) E/M under, that depends on the payer, and the circumstances surrounding the actual visit. If it's not Medicare, check your contracts to see if incident-to billing is even allowed (sometimes referred to as 'pass-through' billing with commercial payers) - there will likely be criteria that has to be met, if so.
If it is Medicare, then the only way to bill incident-to, is if:
A) the physician was physically in the building at the time services were rendered - as in, in the same office suite - not down the hall performing surgery, or in the cafeteria on the next floor, or out in the parking lot, etc.
B) it's an outpatient encounter - no incident-to is allowed for inpatient visits, and
C) The physician has already established a plan of care for the condition being evaluated - meaning, no new problems (acute conditions are immediate disqualifiers), and no new patients. It doesn't matter that he signed off... if all 3 of those conditions weren't met - you have to bill under the PA's #'s. Hope that helps!
