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Would this pass an audit? (Physican and PA performing a visit)

  1. #1
    Default Would this pass an audit? (Physican and PA performing a visit)
    Medical Coding Books
    We realize that shared visits do not exist in the office setting. So for those of you billing a consult or new patient visit -

    Have you ever come across this scenario:

    The PA performs part of the visit and the physician performs part of the visit, but the physician is the one who submits billing for the visit. Both the PA's name and the physician's name appear on the note, but the note does not specify who did which part of the visit - and the note is electronically signed by both the PA and the physician...

    Would this pass an audit by an ins. company or by CERT? Or does the consult or new patient visit have to be performed entirely by the physician alone to be billed under the physician? (I think I know the answer to this, but I need supporting and/or opposing view points to help me convince a physician.)

  2. #2
    Consults can not be split/shared per CMS. Same thing appears to hold true for new patients per this document.

    If a patient is new they would not meet incident to requirements therefore the split/shared new patient visit should be billed under the NPP.

    Laura, CPC

  3. #3
    Columbia, MO
    Laura is absolutely 100% correct.

  4. #4
    I agree, thank you for your responses. And the link will help me convince my physician.

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