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PA or NP writing up consults or HP in patient for MDs, billable.

Jean Answered Tue 07th of June, 2011 15:07:10 PM

If a PA or NP see an admitted patient for Initial visit or consult and then the attending MD sees the patient, writes a note that PA and NP note reviewed and they agree, they write an additional short statement, is this billable by the MD? I am confused because I keep hearing NP/PA "in-patient" consults/visits are not shared.

SuperCoder Answered Tue 07th of June, 2011 16:07:27 PM

The PA or NP can not bill as per above documentation "Incident To" criteria. But if the "Incident To" criteria are not met, the PA can still perform the service; however, the PA’s services must be billed to Medicare under the PA’s own number for reimbursement at 85 percent of the physician fee schedule.

Jean Answered Tue 07th of June, 2011 17:57:39 PM

But may the MD bill for the service because he reviews everything and writes a note verifying that he agrees with all the findings of the NP/PA?

SuperCoder Answered Tue 07th of June, 2011 18:41:35 PM

To bill MD, three criteria are must, (which is not the case here):
1. The physician must have personally treated the patient on his or her initial visit for the particular medical problem and established the diagnosis and treatment plan. The physician must also diagnose and establish a treatment plan for any new medical conditions that may arise.
2. The physician is within the suite of offices when the PA renders the service.
3. The service is within the PA’s scope of practice and in accordance with state law.

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