Wiki IP Hospital E/M serivce

vgriffin

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My doctor does not work at the hospital, but the hospital has a PA they hired to help.

The E/M service is authored by the PA, and the documentation states: "Patient was seen and discussed with my doctor. Nothing documented from my doctor in the note at all, he just does a Co-Signature on the note. I just want to confirm that this would not be a billable service since the doctor did not dictate his portion of the E/M service and the PA does not work for our company.

Any help is appreciated before I present my case to him.
 
That's correct, 'incident to' billing is not allowed in a facility setting, and is also only allowed when the person providing the services is an employee of the physician. If the PA works for the hospital, the physician may not bill for that person's services. There is no separate E&M code for just reviewing or co-signing a note - if the physician wishes reimbursement for the time and work of supervising the PA, he may wish to negotiate something with the hospital to compensate him for that service since only the hospital may bill and be paid for the services of the PA if they are the employer.

'Incident to' guidelines as pertain to E&M services performed in a hospital can be found in the Medicare Claims Processing Manual, Chapter 12, section 30.6.1 beginning on page 30, and in the Medicare Benefit Policy Manual, Chapter 15, section 60, beginning on page 78, links below:

 
Thank you. If the PA mentioned he was just scribing and the patient was seen by MD, then this would be billable?
 
Yes, PAs may act as scribes. The note should indicate the PA acted as a scribe only. The physician must sign and in my hospital, they must also add a line that they personally performed the service and agree with the note.
My personal 2 cents is that a PA acting as a scribe is a waste of salary. Either hire scribes for 1/8 the salary, or use the PA for when the physician can't be there.
 
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