Get Paid For PA Supervised By Gastroenterologist
Published on Tue Aug 01, 2000
The Balanced Budget Act, which was signed into law in August 1997, removed many of the restrictions on Medicare reimbursement for services provided by physician assistants (PAs). Three years later, however, many gastroenterologists are still confused about how to bill for evaluation and management (E/M) visits and procedures handled by a PA.
Although PAs can perform a variety of gastrointestinal procedures, most seem to focus on three main activities, according to Rick Davis, a PA at the University of Florida at Gainesville College of Medicine, Division of Gastroenterology, Hepatology and Nutrition.
1. Performing flexible sigmoidoscopies: Many PAs perform flexible sigmoidoscopies for their practice or for a colorectal cancer screening clinic, says Davis. If the patient needs a biopsy, polypectomy or any procedure that requires sedation, then he or she is referred to a gastroenterologist.
2. Managing chronic hepatitis patients: As the number of patients with chronic hepatitis continues to climb, much of their long-term follow-up treatment is being handled by PAs. The physician assistant will order and review lab tests, adjust the patients medications and perform education and lifestyle counseling, Davis explains.
3. Evaluating new and established patients: Davis primarily handles evaluation and management (E/M) visits with both new and established patients. I take the patients history, perform the physical exam and work up a plan of treatment, he explains.
Billing for Services Under Direct Supervision
Reimbursement for services provided by a physician assistant will fall into one of two categories direct personal supervision and general supervision. According to the Medicare Carriers Manual, Direct personal supervision in the office setting does not mean that the physician must be present in the same room with his or her aide. But the physician must be present in the office suite and immediately available to provide assistance and direction throughout the time the aide is performing services.
PA services performed under direct supervision will be reimbursed at 100 percent of the standard fee for the procedure, according to Michael Powe, director of health systems and reimbursement at the American Academy of Physician Assistants in Alexandria, Va. The PA must be an employee of the medical practice. The service will be billed under the gastroenterologists provider number, and reimbursement will be paid to the PAs employer.
General Supervision Services Receive 85 Percent
Powe defines general supervision as when the PAs supervising gastroenterologist is available for consultation via electronic communication, such as the telephone. If the gastroenterologist is going to be out of the office and at the hospital for much of the time, the services of the physician assistant will more likely fall under this category of general supervision.
Reimbursement for services provided by PAs under general supervision will be at [...]
