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Thread: Need Help Please

  1. #1
    Join Date
    Apr 2007

    Exclamation Need Help Please

    AAPC: Back to School
    How would you bill an ov code if the PA saw the patient 1st, then the doctor came in and gave injection in the knee. PA dictated note of hx, findingx, ect, and doctor dicated quick note that PA saw patient and he administered the inj, would it be just one E/M code? Thanks

  2. #2
    Join Date
    Apr 2007
    Albany, NY

    Default Depends on the insurance...

    Regardless of insurance it would be one code, but if it's Medicare (or a payer that follows Medicare) who it was billed under depends on whether or not "incident to" requirements are met:

    (from CMS)

    Office/Clinic Setting
    In the office/clinic setting when the physician performs the E/M service the service must be reported using the physician‟s UPIN/PIN. When an E/M service is a shared/split encounter between a physician and a non-physician practitioner (NP, PA, CNS or CNM), the service is considered to have been performed “incident to” if the requirements for “incident to” are met and the patient is an established patient. If “incident to” requirements are not met for the shared/split E/M service, the service must be billed under the NPP‟s UPIN/PIN, and payment will be made at the appropriate physician fee schedule payment.

    (from AAD)

    Incident to requirements:

    To bill Medicare "incident to" for services provided by an NPP the following criteria must be met:
    • The service performed must be one that is typically performed in a physician's office.
    • The service performed should be within the scope of practice of the NPP and in accordance with state
    • The physician must personally treat the patient on the patient's first visit to the practice or treat any
    established patient who comes to the office with a new medical condition. NPPs may provide follow-up
    • The physician must be in the suite of offices (on-site) when the NPP is rendering the service.

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