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Blackhorse Posted Sun 31st of December, 2017 19:44:08 PM
Per Medical Board of CA, a Physician Assistant can performing minor surgery. He performs injection, 20610 when patient complains about knee pain and documentation doesn't dictate that the supervising doctor ordered the injection. He bills incident-to which will be paid by MD's fee schedule. There is supervising MD's signature on the bottom of the dictation. Is this a legal charge?
SuperCoder Answered Tue 02nd of January, 2018 04:58:34 AM

Yes, this would be considered legal charge since MD's signature is at the bottom. MD signature at the bottom assures that the MD agrees with the services performed by the PA. 

SuperCoder Answered Tue 02nd of January, 2018 05:00:11 AM

Yes, this would be considered legal charge since MD's signature is at the bottom. MD signature at the bottom assures that the MD agrees with the services performed by the PA. 

Blackhorse Posted Tue 02nd of January, 2018 11:49:40 AM
What if this is a new patient? Can PA see new patient even if the MD's signature is on the bottom of the dictation?
SuperCoder Answered Thu 04th of January, 2018 01:46:16 AM

When an NP/PA sees a patient for a new problem, he/she will need to bill under his/her own PIN (Tax id). Incident-to guidelines do not allow an NP to bill incident-to a physician’s services (i.e., under the physician’s PIN) when a new problem is addressed. This could happen in a situation when the patient was scheduled to be seen for an established problem but brings up a new problem during the course of the visit.  Once a new problem is introduced, the visit would need to be billed under the NPP’s PIN, not the physician’s PIN.

Blackhorse Posted Tue 09th of January, 2018 16:50:11 PM
My senior coder says that PA can see new patient without doctor's supervision, and bill under their own NPI. We'll just not bill incident-to. Is this correct? My question is if PA see new patient, can MD see patient for the 2nd and 3rd time, or this patient has to stick with PA all the time. If the MD see the same pt the 2nd time, will the MD follow PA 's treatment plan? I'm really confused now. I guess there are two ways of billing for PA: incident-to and PA. If PA just wants to bill under their own NPI, they can do whatever they want to do?
Blackhorse Posted Tue 09th of January, 2018 17:04:45 PM
In another words, PA see a new pt on Monday under his PA NPI, MD sees the same pt on Tuesday, PA sees the pt under PA's NPI on Wednesday, maybe PA wants to bill incident-to on Thursday? Does it make any sense.
Blackhorse Posted Tue 09th of January, 2018 17:18:18 PM
Or PA sees a pt for 4 visits under his own NPI, MD sees pt on the 5th time. PA use incident-to on the 6th time, is this allowed?
SuperCoder Answered Wed 10th of January, 2018 06:05:44 AM

PAs can personally perform any new patient visit. They can also personally perform and bill for consults. There does not need to be physician contact with the patient. Legal supervision by state guidelines must be maintained (electronic or tele-communication) and the service should be billed under the PA's name and NPI number. Bill the full physician rate and Medicare will pay at 85 percent of the physician rate

For a medical practice to bill for medical services provided by PAs under the "incident to" provision, the following criteria must be met:

The service must be one within the PAs scope of practice and in accordance with state law.

The service must be one that is typically performed in the physician's office

The supervising physician (or physician members of the same group) must be in the suite offices when the PA renders the service

The physician must personally treat the patient and establish the diagnosis on the patient's first visit to the practice. The physician must also treat established patients who come to the practice with a new medical condition.

 

"Incident to" requires that the physician treat new Medicare patients or established patients with new medical problems. PAs can provide follow-up care for established patients with established problems under this provision.

 

Medicare does not require that PAs bill under the "incident to" billing provision. PAs can always treat all Medicare patients (new or established with a new medical problem) and bill under their own provider numbers. Reimbursement is made to the employer at 85% of the fee schedule and state law determines supervision requirements.

 

Billing under the PA's own provider number allows PAs to see new Medicare patients, patients when the physician is off site, or established patients with new problems.

 

NOTE: The scenario mentioned above will not get paid by the insurance company as it would suspect of an double billing/fraud on part of the provider billing same services on consecutive days with different NPI but under same tax id. On a daily basis these scenarios are not encounetered.

The summary would be PAs can personally perform any new patient visit. Service should be billed under the PA's name and NPI number.   

Please find below the link for more understanding on the topic:

 

http://www.fapaonline.org/page/faqreimbursement#question1

 

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