Answer Hospital Visits for PA

cliff.chen89

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If a PT was seen by the PA in the Emergency room and later admitted inpatient to the hospital, can we bill under the Dr's NPI if the Dr signs an attestation on the PA's note? Or does the Dr have to see the PT face to face? Do PA visits need to have modifier SA on them?
 

cliff.chen89

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Hey Birdie thanks a lot for the response! I've been waiting quite a while ever since I first posted this question in more detail a while back with no response.

Can closed treatment of fractures be billed under PA's NPI if not assisting an MD?
I've heard both yes and no and the answers usually fall into either:

NO: According to Physician Fee Schedule Relative Value, all closed treatment CPT codes are "1" and thus not billable for "Assist at Surgery"

YES:
1)"Assistant at Surgery" is defined as a: physician who actively assists the physician in charge. Which I'm interpreting in this scenario meaning if there's 2 Providers (An MD and a PA) treating the PT. Since PA is not assisting MD and closed treatment is being billed under PA NPI with no MD, the "Assist at Surgery" indicator rule don't apply
2) If the Physician does not document face-to-face time with the PT then according to this article, the services must be billed under PA's NPI

Have you ever encountered this scenario before and what are your thoughts?
 

Birdie625

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Hi - I please see my reply(ies) in CAPS. I am "not" yelling , but don't know how to separate my reply from your questions by bolding, etc....Sadly I cant figure out the formatting works in these posts (nothing happens when I click on anything)....sorry!

ALSO - it appears a bit of Incident-to questions which I am really not confident with. I see that a lot where I work, but never could wrap head around it.... it may depend on how the credentialing is, type of organization, etc you are dealing with.

Hope that helps!

Hey Birdie thanks a lot for the response! I've been waiting quite a while ever since I first posted this question in more detail a while back with no response.

Can closed treatment of fractures be billed under PA's NPI if not assisting an MD? .....YES....

I've heard both yes and no and the answers usually fall into either:

NO: According to Physician Fee Schedule Relative Value, all closed treatment CPT codes are "1" and thus not billable for "Assist at Surgery"---IF PA WAS ASSISTING FOR SUCH NO PYMNT WOULD BE MADE d/t CPT rules for code

YES:
1)"Assistant at Surgery" is defined as a: physician who actively assists the physician in charge. Which I'm interpreting in this scenario meaning if there's 2 Providers (An MD and a PA) treating the PT. Since PA is not assisting MD and closed treatment is being billed under PA NPI with no MD, the "Assist at Surgery" indicator rule don't apply --- CORRECT to your question, but the Yes answer depends on the rule of any particular CPT. (example - 27130-total hip arthroplasty - Assistant indicator = 2 (see below)

2) If the Physician does not document face-to-face time with the PT then according to this article, the services must be billed under PA's NPI ---- YES

Have you ever encountered this scenario before and what are your thoughts?

1 = Statutory payment restriction for assistants at surgery applies to this procedure. Assistant at surgery may not be paid.:)2 = Payment restriction for assistants at surgery does not apply to this procedure. Assistant at surgery may be paid.
 
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