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Thread: Billing p.a. Consults?

  1. #1
    Join Date
    Apr 2007

    Default Billing p.a. Consults?

    AAPC: Back to School
    When a PA dictates an HnP and Dr. signs off on it Is this billable by Dr.? If he does confirm "reviewed and agreed with PA" Thanks for any help

  2. #2
    Join Date
    Apr 2007
    Lubbock, TX


    Quote Originally Posted by herrera4 View Post
    When a PA dictates an HnP and Dr. signs off on it Is this billable by Dr.? If he does confirm "reviewed and agreed with PA" Thanks for any help
    Negative for a consult. You can bill a regular E/M, but a consult requires certain elements to really be considered a consult:

    1. A request for a doctor's opinion (i.e., a consultation), must be made by a qualified source (eg, another doctor, PA, social worker, etc. - there's a list in the CPT book under the guidelines on page 17)
    2. The consulting doctor gives his opinion/advice, in a formal written report, back to the requesting source.
    3. All of the above is documented in the patient's medical record.

    As far as who to bill the (non-consultation) E/M under, that depends on the payer, and the circumstances surrounding the actual visit. If it's not Medicare, check your contracts to see if incident-to billing is even allowed (sometimes referred to as 'pass-through' billing with commercial payers) - there will likely be criteria that has to be met, if so.

    If it is Medicare, then the only way to bill incident-to, is if:
    A) the physician was physically in the building at the time services were rendered - as in, in the same office suite - not down the hall performing surgery, or in the cafeteria on the next floor, or out in the parking lot, etc.
    B) it's an outpatient encounter - no incident-to is allowed for inpatient visits, and
    C) The physician has already established a plan of care for the condition being evaluated - meaning, no new problems (acute conditions are immediate disqualifiers), and no new patients. It doesn't matter that he signed off... if all 3 of those conditions weren't met - you have to bill under the PA's #'s. Hope that helps!

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