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PA Hosptial Billing

  1. #1
    Default PA Hosptial Billing
    Medical Coding Books
    If the PA admits, consults, and f/u visits, and the physician reviews the notes and agree's w/ the treatment plan, it is not possible for the PA to bill under the physicians npi#. Am i correct. The physician would have to personally provide these elements in order to bill under their NPI

  2. #2
    You are correct, there is no incident to on the inpatient side.

    Laura, CPC

  3. #3
    Default PA billing
    If the physician makes a face to face portion fo the E/M encounter, then can the PA bill all the these services under the physicians' npi #.

  4. #4
    Per CMS, yes. Keep in mind that consults can not be split/shared E/M services, so this would not apply to the consult codes.

    Hospital Inpatient/Outpatient/Emergency Department Setting
    When a hospital inpatient/hospital outpatient or emergency department E/M is shared between a physician and an NPP from the same group practice and the physician provides any face-to-face portion of the E/M encounter with the patient, the service may be billed under either the physician's or the NPP's UPIN/PIN number. 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 UPIN/PIN. Payment will be made at the appropriate physician fee schedule rate based on the UPIN/PIN entered on the claim.
    1. If the NPP sees a hospital inpatient in the morning and the physician follows with a later face-to-face visit with the patient on the same day, the physician or the NPP may report the service.

    Laura, CPC

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