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?