Wiki PA E/M Billing - Inpatient Hospital


Charm City - Baltimore
Best answers
Hello -

We have PA's that work with the Intensivists & Hospitalists. They are not allowed to be the attendings. However, they dictate the note and then the physician comes in and signs off on the work either after having seen patient face-to-face and then it is billed under the physician. The question was raised would there be anything that prohibts a PA from billing under their own NPI when they are not the attending and when the provider only reviews the medical record?

Below is the statement I found from Trailblazer July 2010 regarding this.

"However, if there was no face-to-face encounter between the patient and the physician (e.g., even if the physician participated in the service by only reviewing the patient's medical record) then the service may only be billed under the NPP's NPI."

That is a statement from CR1776 issued in 2002 regarding a shared encounter, to be billed under the physician the physician must have a separate note indicating his evaluation of the patient and acknowledgement of the PAs work.
We bill under a mid-level often because either the provider did not round that day or did not document enough to bill under the provider.