Orthopedic Coding Alert

Question: Our orthopedic surgeons are thinking of hiring a physicians assistant (PA). Can a PA bill separately for a history and physical? Can a PA bill as an assistant surgeon for procedures like total hip replacements, total knee replacements and anterior cruciate ligament (ACL) repairs? If yes, is the orthopedic surgeons reimbursement reduced?

Pennsylvania Subscriber

Answer: Regulations vary from state to state as to the limits of a PA, says Victoria Jackson, administrator/CEO of Southern Orange County Pediatric Association in El Torro, Calif. Most states and insurance companies require the PA to bill under the providers name and personal identification number. A PA can provide routine and specialty care, but, as an assistant surgeon, for billing purposes the PA cannot perform these procedures. There is an excellent Web site at www.physicianassociate.com, which can assist you with answers to frequently asked questions. In addition, the school which your PA has attended should be able to give you information.

There has to be a supervising physician within your office who is responsible for monitoring the work of the PA on a daily basis, as well as reviewing and co-signing charts. While it is not necessary to review all charts, the protocols must be set up and agreed to as a condition of employment.

In addition, Medicare also has specific limits to the types of services provided by a PA billing under the physicians name. PAs may also get their own provider number for Medicare, which allows them more flexibility in the types of services billable to Medicare.