Primary Care Coding Alert

Question: If a patient is being treated by a doctor for recurrent urinary tract infections (UTIs), and a physician’s assistant (PA) prescribes an antibiotic for the condition, would the PA be regarded as acting incident to the physician and the encounter billed under the doctor?

Arizona Subscriber

Answer: The answer to this question is dependent on the context for the encounter. For example, suppose the patient initially saw the doctor, who told the patient to drink water and cranberry juice in hopes that the condition might be resolved without prescribing antibiotics. However, the patient returns ten days later with no improvement. As the patient is already under a plan of care that the doctor has established for an existing diagnosis, the PA is acting under that plan, and the encounter can be billed under incident-to guidelines providing the provider is in the building at the time and all other incident-to requirements are met.

However, if the patient is returning after the initial UTI has resolved but is complaining of the same symptoms, this would be regarded as a new problem, and you would not be able to bill the encounter as incident-to under the doctor.