# physician assistant billing



## duerheimergm (Jun 16, 2010)

one of our PA's attended the Annual AAPA conference and the lecturer stated,"Existing patients with NEW conditions can be billed as a level 4." Is there any accuracy to this statement?

any help will be appreicated
thank you,
Gerri Duerheimer, CPC
Virginia


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## lostone65 (Jun 16, 2010)

I'm a little confused about your question.  If you mean a level 4 established patient 99214, then it can be billed as long as the office visit meets the level  criteria.  If you are talking a level 4 new patient visit 99204, then it can only be billed if the patient has not been seen in your practice by any of your physicians in the last 3 years and meets level 4 criteria.  i am not sure if that is what you were looking for.


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## code4you123 (Jun 16, 2010)

*PA coding*

Established patients with new problems should not be seen by the PA, CMS requires the MD must see these patients. Reference, "Incident to" Medicare Part B payment policy is applicable for office visits when the requirements for "incident to" are met (refer to sections 60.1, 60.2, and 60.3, chapter 15 in IOM 100-02).

As for the level IV coding, documentation and *medical necessity* is required to support the E&M level IV services, new problem or not.  Reference the CMS billing manual; 30.6.1 - Selection of Level of Evaluation and Management Service, for more information.


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## TamaraM (Jun 17, 2010)

*PA billing level 4's*

Is the question simply that a PA can code a level 4 office visit??
If so -yes we have a PA in our office and as long as he meets the criteria for a level 4 we bill it.


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## RebeccaWoodward* (Jun 17, 2010)

duerheimergm said:


> one of our PA's attended the Annual AAPA conference and the lecturer stated,"Existing patients with NEW conditions can be billed as a level 4." Is there any accuracy to this statement?
> 
> any help will be appreicated
> thank you,
> ...




Gerri,

*For the purpose of Medicare:* 

Depending on state law/scope of practice, a PA can see an established patient with a *new* problem; however, the claim must be submitted under the PA's identifying information.  "Incident to" would not be applicable in this situation.  As for coding a 99214, if you have met the qualifying components along with medical necessity, it's possible to justify this level.

Section 190-

http://www.cms.gov/manuals/Downloads/bp102c15.pdf


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