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physician assistant billing

  1. Red face physician assistant billing
    Medical Coding Books
    one of our PA's attended the Annual AAPA conference and the lecturer stated,"Existing patients with NEW conditions can be billed as a level 4." Is there any accuracy to this statement?

    any help will be appreicated
    thank you,
    Gerri Duerheimer, CPC
    Virginia

  2. #2
    Default
    I'm a little confused about your question. If you mean a level 4 established patient 99214, then it can be billed as long as the office visit meets the level criteria. If you are talking a level 4 new patient visit 99204, then it can only be billed if the patient has not been seen in your practice by any of your physicians in the last 3 years and meets level 4 criteria. i am not sure if that is what you were looking for.

  3. Default PA coding
    Established patients with new problems should not be seen by the PA, CMS requires the MD must see these patients. Reference, "Incident to" Medicare Part B payment policy is applicable for office visits when the requirements for "incident to" are met (refer to sections 60.1, 60.2, and 60.3, chapter 15 in IOM 100-02).

    As for the level IV coding, documentation and medical necessity is required to support the E&M level IV services, new problem or not. Reference the CMS billing manual; 30.6.1 - Selection of Level of Evaluation and Management Service, for more information.

  4. Default PA billing level 4's
    Is the question simply that a PA can code a level 4 office visit??
    If so -yes we have a PA in our office and as long as he meets the criteria for a level 4 we bill it.

  5. #5
    Location
    North Carolina
    Posts
    3,126
    Default
    Quote Originally Posted by duerheimergm View Post
    one of our PA's attended the Annual AAPA conference and the lecturer stated,"Existing patients with NEW conditions can be billed as a level 4." Is there any accuracy to this statement?

    any help will be appreicated
    thank you,
    Gerri Duerheimer, CPC
    Virginia

    Gerri,

    For the purpose of Medicare:

    Depending on state law/scope of practice, a PA can see an established patient with a new problem; however, the claim must be submitted under the PA's identifying information. "Incident to" would not be applicable in this situation. As for coding a 99214, if you have met the qualifying components along with medical necessity, it's possible to justify this level.

    Section 190-

    http://www.cms.gov/manuals/Downloads/bp102c15.pdf

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