# Physician's assistant for pain management



## larkatin (Nov 16, 2009)

What do I look under to research employing and billing for a physician's assistant who specializes in pain management?  We have never employed and therefore, never billed for any physician assistants or nurse practictioners.  We are researching the pros and cons of such, so any guidance would be greatly appreciated.


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## Walker22 (Nov 16, 2009)

We employ both NP's and PA's in our pain practice. What kind of questions do you need answered?


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## larkatin (Nov 17, 2009)

What are the scopes of practice for each and how do you bill for their services?  Is this where "incident-to" comes in to play?  What roll do they have in your practice?  Thank you.


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## Walker22 (Nov 17, 2009)

The physician does the intial eval and sets up a treatment plan. The PA's then do the follow up visits, which the physician then reviews and signs off on. We bill the PA's incident-to the physician bill. The physician tries to see the patient about every third visit as long as there are no new complaints. If a patient has a new complaint, the PA turns the encounter over to the physician to come up with a treatment plan, and then it starts all over.


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## AYCPC (Nov 18, 2009)

*Question re pain management e&m*

I was instructed the type of narcotics our clinic uses warrants a higher E&M level since they are considered schedule 3/4. I cannot locate any documentation to confirm/deny this. What are your thoughts on this?

Thanks,
Amanda


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## Walker22 (Dec 2, 2009)

The prescribing of schedule 3 or 4 narcotics does not automatically entitle you to a higher level of service. It's all based on documentation. If your provider does not document everything that the 1995 or 1997 E&M Guidelines calls for, then you can't bill for it. Remember the old saying, "Not Documented, Not Done" !!


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