Wiki Consult or New Patient

[j.berkshire]

I'm interested in any thoughts or comments for this scenario:

A physician assistant is seeing a new patient. There is a request from a referring physician for a consult and the PA has sent a report back to the referring. The patient's health plan will pay for consults, but not by a PA. The health plan will pay for new patient services provided by a PA. A physician was onsite. Would you bill this as a PA-provided new patient?

 

[btadlock1]

I'm interested in any thoughts or comments for this scenario:

A physician assistant is seeing a new patient. There is a request from a referring physician for a consult and the PA has sent a report back to the referring. The patient's health plan will pay for consults, but not by a PA. The health plan will pay for new patient services provided by a PA. A physician was onsite. Would you bill this as a PA-provided new patient?

You can't bill a consult by a PA. Consults, by definition, must be performed by a physician. I'd go with new patient office visit, and if he provided a written report back to the physician that requested the consult (also required to bill a consult), you might be able to justify adding a 22 modifier for increased procedural services, but it would be a long shot. Hope that helps!