Kevinph84
Guest
Physician Assistant E&M Global Billing, Between Two PAs Working Under Different Speci
My Fellow Coders,
I'm a certified coder working at a multi-specialty clinic with over seventy providers. We have a situation develop when billing services for our physician assistants. I was wondering if I could get some of your help and expertise?
The PAs we have work under various specialties. Some work in the Coumadin clinic, some for cardiology, you pretty much grasp the idea. The problem I have is that one PA will bill a procedure with a global period, but then all the other PA services afterwards, regardless of the physician's specialty they work under, will deny for global period.
Example:
In the Orthopedics department, the PA will charge a procedure with a 10 day global. The next day, the patient sees a PA for Coumadin Clinic under the Internal Medicine department. Medicare denies that visit for being in the global package.
I spoke with First Choice Options Medicare phone service to establish a resolution, but they had instructed me to just slap the 24 modifier on the denied visits and re-submit. The 24 modifier from a coding standpoint does not apply for the PA's are being supervised by totally different specialties. At the same time, I can see the 24 application justified from a billing perspective. We bill Medicare under the PA specialty, so the 24 modifier might be the right thing to get the claim paid.
I didn't feel too confident with the results over the phone, so I looked for something in writing from Medicare. I really haven't found anything concrete supporting to just add a 24 modifier.
Has anyone experienced a similar situation or perhaps has some resolution? If so, could you direct me as to where I can find that information in writing? Thank you all for your help! Please feel free to respond on here or my personal e-mail: Kevinph84@msn.com
Respectfully Yours,
Kevin P. Honig, CPC
My Fellow Coders,
I'm a certified coder working at a multi-specialty clinic with over seventy providers. We have a situation develop when billing services for our physician assistants. I was wondering if I could get some of your help and expertise?
The PAs we have work under various specialties. Some work in the Coumadin clinic, some for cardiology, you pretty much grasp the idea. The problem I have is that one PA will bill a procedure with a global period, but then all the other PA services afterwards, regardless of the physician's specialty they work under, will deny for global period.
Example:
In the Orthopedics department, the PA will charge a procedure with a 10 day global. The next day, the patient sees a PA for Coumadin Clinic under the Internal Medicine department. Medicare denies that visit for being in the global package.
I spoke with First Choice Options Medicare phone service to establish a resolution, but they had instructed me to just slap the 24 modifier on the denied visits and re-submit. The 24 modifier from a coding standpoint does not apply for the PA's are being supervised by totally different specialties. At the same time, I can see the 24 application justified from a billing perspective. We bill Medicare under the PA specialty, so the 24 modifier might be the right thing to get the claim paid.
I didn't feel too confident with the results over the phone, so I looked for something in writing from Medicare. I really haven't found anything concrete supporting to just add a 24 modifier.
Has anyone experienced a similar situation or perhaps has some resolution? If so, could you direct me as to where I can find that information in writing? Thank you all for your help! Please feel free to respond on here or my personal e-mail: Kevinph84@msn.com
Respectfully Yours,
Kevin P. Honig, CPC
