Results 1 to 2 of 2

Consult or New Patient

  1. #1
    Default Consult or New Patient
    Medical Coding Books
    I'm interested in any thoughts or comments for this scenario:

    A physician assistant is seeing a new patient. There is a request from a referring physician for a consult and the PA has sent a report back to the referring. The patient's health plan will pay for consults, but not by a PA. The health plan will pay for new patient services provided by a PA. A physician was onsite. Would you bill this as a PA-provided new patient?
    Jenny Berkshire, CPC, CEMC, CGIC

  2. #2
    Default
    Quote Originally Posted by j.berkshire View Post
    I'm interested in any thoughts or comments for this scenario:

    A physician assistant is seeing a new patient. There is a request from a referring physician for a consult and the PA has sent a report back to the referring. The patient's health plan will pay for consults, but not by a PA. The health plan will pay for new patient services provided by a PA. A physician was onsite. Would you bill this as a PA-provided new patient?
    You can't bill a consult by a PA. Consults, by definition, must be performed by a physician. I'd go with new patient office visit, and if he provided a written report back to the physician that requested the consult (also required to bill a consult), you might be able to justify adding a 22 modifier for increased procedural services, but it would be a long shot. Hope that helps!

Similar Threads

  1. Help! Consult or New Patient?
    By surfroxy223@yahoo.com in forum E/M
    Replies: 2
    Last Post: 09-22-2015, 03:36 PM
  2. consult vs new patient
    By cdavis022972 in forum E/M
    Replies: 1
    Last Post: 11-26-2014, 08:55 AM
  3. EP New Patient or Consult
    By lpick in forum Cardiology
    Replies: 2
    Last Post: 05-30-2012, 10:16 AM
  4. New patient or Consult
    By sky in forum Medical Coding General Discussion
    Replies: 3
    Last Post: 08-31-2010, 03:34 PM

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?

Login

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.