Wiki New vs Est for PAs

[raeann]

Scenario:
Multi-specialty facility (ortho, pain management, neuro)
Patient sees Dr. Smith (Orthopedics) and then has surgery with Dr. Smith. Four months later, patient is referred to same facility for Pain Management and is seen by the PA of the Pain doc.

Question: Since PAs do not have specialties themselves, is this patient billed as new or established for the PA pain OV?

Thanks!

 

[thomas7331]

I've found that different payers handle this situation differently. For payers that do not assign a specialty to the PA, you may be able to bill a new patient visit (assuming the patient did not see another PA in your practice). But my feeling is that the most correct way to code PA office visits is to treat them as being of the same specialty as the supervising provider they are working under as that is really the intent of the new vs. established definition. To represent a patient as new again to the same specialty just because of the different credential is not really accurate and usually won't get you better reimbursement anyway since the new patient codes require a higher level of documentation.

 

[raeann]

Thank you! Much appreciated!