Orthopedic Coding Alert

Question: We have a physician assistant on staff. Can he use the E/M codes to treat new patients? Connecticut Subscriber Answer: Not if the PA is billing services as "incident-to" the physician's services. Under Medicare's incident-to billing guidelines, if the claims are being submitted using the supervising physician's PIN, the orthopedist must have seen the patient at a previous encounter and developed a plan of care. If, however, the PA bills directly under his own PIN, he may examine and treat new patients as long as he is operating within the scope of his state licensure. When billing private payers, the PA must abide by any contractual limitations placed by the insurer.