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Question about NPP and procedure done by doc

  1. #1
    Default Question about NPP and procedure done by doc
    Clearnace Sale
    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
    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
    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
    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..

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