ED Coding and Reimbursement Alert

Question: I'm having difficulty getting reimbursed for the work of our physician assistants (PAs) by private insurance companies. The PAs see only level-one and -two patients without supervision. I was instructed to bill office visit codes for these emergency room visits, but I don't feel that this is appropriate. How should I report these services?

Answer: This situation can get tricky because the scope of allowable practice for PAs varies by state. Many PAs are not restricted in the types of patients they may treat. However, some private carriers and regional Medicaid carriers have specific policies, so you'll probably need to investigate a little to find out the rules that apply to you.

If your carrier does not recognize PAs or offer the opportunity to obtain provider numbers, then your default option is to bill the service under the supervising physician's personal identification number. Remember that Medicare does indeed recognize the services of PAs and, therefore, all PAs must have their own provider numbers. For more information concerning visits shared between MDs and PAs, see CMS' transmittal 1776 online at http://cms.hhs.gov/providerupdate/october2002/ midquarter.asp.

- Reader Questions and You Be the Coder reviewed by Mike Granovsky, MD, CPC.