Gastroenterology Coding Alert

Since chronic hepatitis patients often require long-term follow-up treatment from physician assistants, you must remember how to properly bill services "incident-to" a physician's service.

Payment criteria fall under two categories: direct supervision and general supervision. The Medicare Carriers Manual states that the services of a PA can be covered as incident-to the services of a physician. The services "must be an integral, although incidental, part of the physician's personal professional services, and they must be performed under the physician's direct supervision." "Direct supervision" means that the physician is in the office suite and available to provide assistance throughout the PA's services. Services provided under direct supervision will be reimbursed 100 percent of the standard fee and will be paid to the PA's employer.

It is often hard for PAs to provide services under direct supervision. The other option is spelled out in the Balanced Budget Act of 1997. It authorizes the "coverage of services which would be physicians' services if furnished by a physician which are performed by a physician assistant under the supervision of a physician and which the physician assistant is legally allowed to perform by the state in which the services are performed."

The bill removes the restriction on settings and allows payment only if no facility or other provider charges are paid in connection with the service. According to the Balanced Budget Act, "payment would be equal to 80 percent of the lesser of the actual charge or 85 percent of the Physician Fee Schedule."