Wiki Physician Assistant for Pediatrics E/M coding

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haileyd19

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Brand new biller/coder here so be easy on me.

Physician Assistant E/M codes are being denied from multiple insurances and I'm not sure if we are using incorrect modifiers or if there's different E/M rules that I'm not aware of. This particular PA is new to the practice within the last 6-8 months and has had some issues with initial credentialing. Any and all advice for proper modifiers/codes for her services in a pediatric office would be helpful!
 
I am with an Internal Medicine & Pediatric Group that bills a physician assistant. As long as the PA is credentialed you shouldn't have any issues. You may want to check the taxonomy code that is being used for your PA. We have some insurances that want us to use 363AM0700X, Physician Assistant-Medical and some insurances want use to use 363A00000X, Physician Assistant. Also. Do you bill claims under group NPI or individual provider's NPI? If you bill as a group you need to make sure the PA is associated with the group.
 
rthomas@impcna.com said:
I am with an Internal Medicine & Pediatric Group that bills a physician assistant. As long as the PA is credentialed you shouldn't have any issues. You may want to check the taxonomy code that is being used for your PA. We have some insurances that want us to use 363AM0700X, Physician Assistant-Medical and some insurances want use to use 363A00000X, Physician Assistant. Also. Do you bill claims under group NPI or individual provider's NPI? If you bill as a group you need to make sure the PA is associated with the group.
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Just to clarify - you don't modify any E/M codes with UD, SA, or any other modifiers when submitting standard physician office visits to Anthem, UHC, Aetna, Caresource? I haven't seen any AMA specific modifiers for Physician Assistants in my code books, but I think this practice (before I was hired) was having credentialing issues with this provider and started using modifiers for her claims and found some to be successful? They used the phrase "mid level providers" modifiers for NPs and PAs, but I wasn't sure of what is typical/proper. We bill under individual NPIs, but we also have a group NPI that's associated with our office.
 
We do not have to use any special modifiers on our PA. We code and bill out claims for our PA just like we would a physician or nurse practitioner. Our PA is credentialed with all major payers like UHC, BCBS, Aetna, Cigna, Medicare, etc. She has been with us for 8 years and never had issues.
 
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