Primary Care Coding Alert

Question: Our clinic's services include a Medifast weight-loss program. One of our PA-Cs sees all the patients in the program. Our own physicians refer most of the program's patients. Can we code these as consults?


Louisiana Subscriber
 

Answer: The answer to your question could depend on the carrier you-re dealing with.

Medicare's incident-to rules require an established plan of care for an existing condition. Your physician establishes a plan of treatment for the patient (participation in a weight-loss program) that the PA simply follows. Because of this, it appears that the services your PA provides fall into an incident-to scenario--which means you can't bill Medicare for a separate consult for the PA.

You could possibly bill a separate consult if it is an established program and your physician officially refers the patient to the PA. Work with your carrier to verify incident-to guidelines and determine whether it's appropriate to bill the PA's work as a consult.