Question PA e/m coding for Hospital visits?

Best answers
If the PT has a hospital visit/consult where they are seen by the PA. The PA is employed by the Dr and works for the Dr's group/company. The note will have the HPI, the lab results, and then the assessment and plan. But, the MD is not clearly documenting that they saw the PT face-to-face. For example:

PT with L distal clavicle fracture

1. Care per primary team
2. NWB LUE, sling for comfort
3. Pain control
4. Will proceed with conservative management of left distal clavicle fracture
5. Disposition: stable from Ortho standpoint, f/u with Ortho in 2 weeks

Attestation signed by Dr. ABC
Patient who sustained minimally displaced left lateral clavicle fracture after fall on beach. I reviewed patient's medical chart and imaging prior to this consultation. Care plan for treatment established in conjunction with PA as described above. Closed treatment of clavicle fracture recommended with outpatient followup.

Physician Assistant XYZ, PA at (Date & Time of signature)
Cosigned by: Dr. ABC, MD at (Date & Time of signature)

My understanding is that as per this article, unless my doctor specifically writes that they saw the PT face-to-face (e.g. I personally saw the PT on today's date) that I may NOT bill the visit under the Dr's name and instead I have to bill this under the PA's name.

1) In the above example, am I correct in telling my doctor that this cannot be billed under his name, that it can only be billed under the PA's name?

2) If closed treatment is performed as per above example, can I bill the closed treatment under the PA's name even without billing the Dr as the primary/supervising MD? Since in my experience the insurance will deny the PA's surgery bill/services without also submitting the primary/supervising MD bill?

3) Lastly, does the E/M code (99222) and Closed treatment (23500) have to be billed with any modifiers? Do I bill under the PA's name as:


or do I add modifiers:


4) IIRC medicare does not recognize the SA modifiers, so if the insurance is medicare, is there another modifier I should use?

5) Even though this was an emergency and PT was first seen in the emergency room, but they were admitted to the hospital, should I code as 9922X or 9928X?