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Gastroenterology Coding Alert

Reader Question:

Focus PA Efforts and Max Out Payment Potential

Published on Mon Feb 09, 2004

Question: In a gastroenterology office, what kinds of services can a physician assistant provide that Medicare will pay for?

Washington Subscriber

Answer: Since the Balanced Budget Act was signed in 1997, it has been possible for gastroenterology offices to receive more consistent payment when filing a claim in which a physician assistant (PA) handles most or all of the services for the patient. This is good for gastroenterology offices, but it does present an added challenge for coders: knowing which PA-provided services Medicare will pay for, and which ones it won't.

PAs can perform a host of services for gastroenterology patients, but these are the most common services a PA provides:

  • Performing flexible sigmoidoscopies for a gastroenterologist. But if the patient requires a polypectomy, biopsy or some procedure involving sedation, the patient is referred to the gastroenterologist.
  • Managing chronic hepatitis patients. Long-term follow-up care for these patients is often overseen by a PA, who can order lab tests, adjust medications when necessary and give the patient counseling and education.
  • Evaluating new and established patients. A PA can handle evaluation and management visits for both types of patients. Recording patient history, performing a physical exam and devising a treatment plan can all be performed by PAs.

    For payment purposes, Medicare puts PA-provided services into one of two categories: direct supervision and general supervision.

    Direct supervision services will be reimbursed at 100 percent of the standard fee. The gastroenterologist needn't be by the PA's side to qualify for direct supervision, but he must be physically in the office and available to provide any help the PA may need during the service.

    General supervision services will be reimbursed at 85 percent of the standard fee. To qualify for general supervision, the gastroenterologist doesn't have to be on site, but must be available for consultation by electronic communication (cell phone, e-mail, etc.).

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