# Physician Assistant E&M Global Billing, Between Two PAs Working Under Different Speci



## Kevinph84 (Mar 16, 2009)

*Physician Assistant E&M Global Billing, Between Two PAs Working Under Different Speci*

My Fellow Coders,

I'm a certified coder working at a multi-specialty clinic with over seventy providers. We have a situation develop when billing services for our physician assistants. I was wondering if I could get some of your help and expertise? 

The PAs we have work under various specialties. Some work in the Coumadin clinic, some for cardiology, you pretty much grasp the idea. The problem I have is that one PA will bill a procedure with a global period, but then all the other PA services afterwards, regardless of the physician's specialty they work under, will deny for global period.  

*Example:*

In the Orthopedics department, the PA will charge a procedure with a 10 day global. The next day, the patient sees a PA for Coumadin Clinic under the Internal Medicine department. Medicare denies that visit for being in the global package.  

I spoke with First Choice Options Medicare phone service to establish a resolution, but they had instructed me to just slap the 24 modifier on the denied visits and re-submit. The 24 modifier from a coding standpoint does not apply for the PA's are being supervised by totally different specialties. At the same time, I can see the 24 application justified from a billing perspective. We bill Medicare under the PA specialty, so the 24 modifier might be the right thing to get the claim paid.  

I didn't feel too confident with the results over the phone, so I looked for something in writing from Medicare.  I really haven't found anything concrete supporting to just add a 24 modifier.  

Has anyone experienced a similar situation or perhaps has some resolution? If so, could you direct me as to where I can find that information in writing? Thank you all for your help! Please feel free to respond on here or my personal e-mail: Kevinph84@msn.com 

Respectfully Yours,

Kevin P. Honig, CPC


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## RebeccaWoodward* (Mar 17, 2009)

Technically, you shouldn't have to use modifier 24 since the PA's are two different specialties; however, I find that some carriers are not up to par with coding guidelines.

CPT Modifier “-24” - Unrelated Evaluation and Management Service by Same Physician During Postoperative Period
Carriers pay for an evaluation and management service other than inpatient hospital care before discharge from the hospital following surgery (CPT codes 99221-99238) if it was provided during the postoperative period of a surgical procedure, *furnished by the same physician who performed the procedure*, billed with CPT modifier “-24,” and accompanied by documentation that supports that the service is not related to the postoperative care of the procedure. They do not pay for inpatient hospital care that is furnished during the hospital stay in which the surgery occurred unless the doctor is also treating another medical condition that is unrelated to the surgery. All care provided during the inpatient stay in which the surgery occurred is compensated through the global surgical payment.

http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf

Coming from a coding compliance aspect, I think I would bring this CMS guideline to their attention and give them a quick coding 101.


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