If a PA does a consult it must be billed under the PA, Consults and New patients cannot be billed incident to or as a shared encounter. What you are describing is like a shared encounter where the PA performs part of the encounter and the MD does part, but even for a shared encounter the MD must document a face to face encounter with the patient, just signing off on the note is insufficient. You can bill a regular established patient OV under the physician as long as it meets the incident to rule that this is a follow up encounter as long as the provider is on site, or as a shared encounter as long as the MD dictates a separate note indicating his face to face portion and references the PAs note.
If the PA sees a new patient, or an established patient with a new problem, or any patient while the MD is out of the office then the PA must bill using his own NPI number.
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