ED Coding and Reimbursement Alert

Question: How should I bill for the PAs who are doing procedures in the emergency department, such as wound repair, fracture care, burn care, and incision and drainage? Our physicians sign the chart and a supervision note - is that enough documentation to justify billing under the physician's number, or do we still need more for Medicare?


Virginia Subscriber


Answer: In the emergency department, the "shared visits" rule for physician assistant (PA) services applies only to evaluation and management codes. So, when reporting procedure codes to Medicare, you must use the provider number of whoever actually performed the services.

For example, suppose the physician personally provided some of the E/M service to the patient, and then the PA performed a procedure. In this situation, you would bill the E/M codes under the physician's identification number and the procedure with the PA's number. The same caveat applies to nurse practitioners (NPs).

Medicare transmittal 1776 allows you to bill for shared E/M encounters under the physician's personal identification number (PIN) if he or she documents a clinically meaningful face-to-face encounter. You need to report procedures done by mid-level providers, such as PAs or NPs, under the mid-level's PIN. These services earn a reimbursement of 85 percent of the physician's payment.

Remember: These are Medicare rules only, and private carriers may not separately credential mid-level providers such as PAs and NPs. Private carriers also may not discount mid-level provider payments or care about the supervisory relationship - your best bet is to check on each individual payer's policy before dropping the claim.