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PA (physician's assistant) Billing

Margaret Posted Mon 06th of February, 2017 15:05:12 PM
Can you please clarify the correct way to bill for a PA when they treat patients in our orthopedic office on follow up from the hospital after treatment either closed or by surgery for a fracture when an additional minor procedure is performed. Should it be billed under the physician? Most times there is a physician in the office but at times there is not. Treatment would be for perhaps pin removal or irrigation and debridement due to infection, etc.. Also if a PA sees a patient in the ER prior to the surgeon coming to see the patient, can we bill for their services? Thank you for any information you can give me.
SuperCoder Answered Tue 07th of February, 2017 03:53:44 AM

Greetings from SuperCoder.com!

As per CMS:- “PAs may provide services that traditionally have been reserved to physicians, such as physical examinations, minor surgery, setting casts for simple fractures, interpreting x-rays, and other activities that involve an independent evaluation or treatment of the patient’s condition.

PA services may not be covered if they are otherwise excluded from coverage even though a PA may be authorized by State law to perform them. For example, the Medicare law excludes from coverage routine foot care, routine physical checkups, and services that are not reasonable and necessary for the diagnosis or treatment of an illness or injury or to improve the functioning of a malformed body member.

PA’s physician supervisor is primarily responsible for the overall direction and management of the PA’s professional activities and for assuring that the services provided are medically appropriate for the patient. The physician supervisor need not be physically present with the PA when a service is being furnished to a patient and may be contacted by telephone, if necessary, unless State law or regulations require otherwise.”

Since the physician supervisor need not be physically present when a service is being furnished, you may bill services provided by PA prior to the surgeon coming to see the patient in the ER. Services are paid at 85% of the amount a physician is paid under the Medicare Physician Fee Schedule (MPFS)

For more info, please see this link:

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c12.pdf

Please feel free to write if you have any concern or questions.

Thanks.

Margaret Posted Tue 07th of February, 2017 14:08:47 PM
Thank you so much for your response and information. I still have confusion when it comes to the ER. When our ortho is on-call for the hospital ER and there is a patient with a nondisplaced closed fracture, can our PA go and treat this patient for the fracture and bill without the ortho going to the ER or does the ortho still have to go to the ER and see the patient. Thank you.
SuperCoder Answered Wed 08th of February, 2017 01:39:24 AM

Hi,

 

PAs are dependent practitioners and supervision may be provided by licensed physician by physical presence or by telephone. Each state has its own supervisory requirements and it is mandatory that the physician and team follows state law where they are practicing. PAs can provide services in ED but their supervising physician should be available either physically or by telephone.

 

Thanks

Margaret Posted Wed 08th of February, 2017 12:51:08 PM
Thank you again. As always your responses are greatly appreciated.
Margaret Posted Wed 08th of February, 2017 12:53:49 PM
Thank you again. As always your responses are greatly appreciated.
SuperCoder Answered Thu 09th of February, 2017 01:24:17 AM

Hi Margaret,

 

We are always happy to serve our invaluable customers.

 

Regards

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