AAPC - Back to school
Results 1 to 4 of 4

Thread: Question about NPP and procedure done by doc

  1. #1
    Join Date
    Apr 2007
    Lehigh Valley

    Default Question about NPP and procedure done by doc

    AAPC: Back to School
    Good afternoon!

    I am not sure what to do in this case and needed opinions.

    Our PA-C evaluated a new patient and the doc also examined the patient and recommended admission to the hospital.

    She was later admitted and underwent I&D in the OR by the same physician who saw her earlier in the day.

    Is it acceptable to bill out the consult under the PA-C numbers with a modifier 25 and bill out the I&D under the doc's numbers? The patient has AETNA insurance, not Medicare or Medicaid.

    Thanks for your help.


  2. #2
    Join Date
    Apr 2007


    This was a split/shared service it doesn't sound like a consult even if its not Medicare. I would bill it as an admit under the doctor (assuming the doctor documented what they did in addition to the PA) with the 25 and the I&D under the doctor as well based on the info you posted.

    Laura, CPC, CEMC

  3. #3
    Join Date
    Apr 2007
    Lehigh Valley


    Hi Laura!

    Thanks for responding. The PA-C dictated the whole HP as well as the office note stating that the doctor saw and examined the patient and developed the following treatment plan. Is this sufficient or should I be asking him to dictate his own portion separately? He did not right a separate note either in the hospital records.


    I just came across this about the PA and I want to be sure that I am doing this correctly. In the consultation report, the PA dictates that the entirety of the consult was including HPI, PE, and MDM were performed by the doctor and the report of the consult is being dictated by the PA.

    Also doctor wrote on the consult request, pt seen and personally examined. Agree with history and exam as scribed by PA. He does mark down abdominal exam, impression, and plan. In this scenario, is it acceptable to bill out under doc's numbers as the PA is acting as a scribe??

    Thanks for your help. It is very much appreciated!


  4. #4
    Join Date
    Apr 2007
    Athens, Ga.


    Based on what you said above, I would say bill as a hospital admit with the doctor's name. It sounds like the PA had very little involvement other than scribing for the doctor. In other words, he didn't perform the HPI, PE, nor the MDM, the doctor did, therefore the PA doesn't get to bill an office visit separately..

Similar Threads

  1. Terminology Question Deciphering my Doc
    By larcwing in forum Medical Coding General Discussion
    Replies: 2
    Last Post: 11-21-2012, 09:56 AM
  2. 1st doc can't complete DRE,2nd doc bills how?
    By uhlerclarem in forum E/M
    Replies: 1
    Last Post: 08-13-2009, 07:22 AM
  3. EM doc mod 25 and procedure on SDOS
    By marymartelloni in forum Modifiers
    Replies: 3
    Last Post: 11-03-2008, 04:49 PM
  4. Question on Preventive Medicine and NPP's
    By Anna Weaver in forum Medical Coding General Discussion
    Replies: 2
    Last Post: 10-28-2008, 07:00 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.