I have a facility that is using a PA to go out and do an exam on a patient for an admit before the admitting physican goes out to do their initial service (this occurs the day before the admitting physician sees the patient). Because the PA is performing a limited service and is not the admitting physician, the facility is billing a subsequent care code for the PA and then the initial code for the admitting physician on the next day. It is my impression that you cannot bill for a subsequent hospital service prior to an initial. The facility insists they can do it because the CPT manual does not state that the initial must be billed first. While it is not specifically stated in writing, I believe that is just inferred by the code description. For the PA service, it does not appear that a consult would fit as the decision to admit is already made and this is a routine method that the facility follows when admitting patients. My sense is that the PA service is not billable and then the admitting physician bills for initial hospital care the day he sees the patient. Anyone have any suggestions?