Orthopedic Coding Alert

Question: Can I charge for a history and physical (H&P) done by our physicians assistant (PA) the day before surgery?

Georgia Subscriber
 
Answer: If performed by the surgeon on the day before or the day of major surgery, the H&P is included in the global surgical package. But if it is the initial consultation by that physician, the E/M code should be reported and modifier -57 (decision for surgery) appended.
 
If your PA has his or her own Medicare provider number or is a credentialed provider with the insurance carrier you are billing, report the PAs services with his or her provider number. But most PA services are reimbursed at a lower rate than MD services.
 
If you split the global package for the procedure by having the PA bill for the preoperative portion using the CPT code for the surgery with modifier -56 (preoperative management only) and the surgeon report the CPT code for the surgery, the carrier will split the fee between your two providers, probably paying a lower rate for the portion of the global service rendered by the PA. However, having the PA do the H&P is a financial benefit to your practice, as it frees up the surgeon to provide other billable services.