Wiki Bill for physican assistants rounding in the hospital

[fhysong]

I wanted to know what other practices are doing who employ Physician Assistants. We have about 20 in our group. When a community based surgeon dose a surgery that one of our PAs DOES NOT assist on is it ok to charge for an in-patient rounding visit if our PA rounds on that patient? There are sometimes when one of our PAs will assist the community surgeons and then they are in a global period, but if no-one from our group assists in the surgery can it be charged.

I have been told that if the PA is rounding on a surgical patient regardless if one of our group has assisted in the surgery or not that it can not be charged out, but I was not given anything in writing from any organization that shows this. I do have this from Medicare:

The global surgical package, also called global surgery, includes all necessary services normally furnished by a surgeon before, during, and after a procedure. Medicare payment for the surgical procedure includes the preoperative, intra-operative, and post-operative services routinely performed by the surgeon or by members of the same group with the same specialty. Physicians in the same group practice who are in the same specialty must bill and be paid as though they were a single physician

These providers are not in the same group.

Any thoughts are greatly appreciated.

thank you

 

[Siva03]

In case of professional billing

NO we cannot bill separately for PA rounds , it will be incident to the surgeons work , again which is getting included in global surgical package.


In facility billing the GSP does not apply , so the facility can bill for its resource utilisation

 

[fhysong]

In case of professional billing

NO we cannot bill separately for PA rounds , it will be incident to the surgeons work , again which is getting included in global surgical package.


In facility billing the GSP does not apply , so the facility can bill for its resource utilisation

I'm just wondering why it would be considered incident to a surgeon that is not employed by the same practice that the PA is employed by. They are not from the same group or specialty. If an internist would round on a cardiology patient who had a procedure done is the internist who is not part of the cardiology group considered global to the cardiologist procedure?

 

[thomas7331]

I'm just wondering why it would be considered incident to a surgeon that is not employed by the same practice that the PA is employed by. They are not from the same group or specialty. If an internist would round on a cardiology patient who had a procedure done is the internist who is not part of the cardiology group considered global to the cardiologist procedure?

You're correct that it can't be 'incident to' the services of a provider in a different practice (and in any case the 'incident to' rules do not apply in a facility). However, I think the previous post perhaps intended to mean that any routine postoperative care provided by a PA in that same specialty would still be a part of the global surgical package even if the PA is in a different practice. The surgeon is reimbursed for all of the routine post-operative care as a part of their fee for the surgery itself. If the intent is to have a different practice take over the postoperative care, then the surgeon should be billing modifier 54 and the new practice which is handling the post-op care will bill the surgical code with modifier 55. If this transfer of care is not done, then the PA is providing a service for which the surgeon was already paid and it would not be appropriate to bill separately for that service.

Your example of a cardiology and internist is a different situation because those are two different specialties. Services of physicians in a different specialty are excluded from the global surgical package, so that is not an issue. Similarly, if your PAs are not performing routine post-operative surgical care, or are practicing in another specialty and/or addressing patient issues unrelated to the surgery and recovery, then there should be no problem billing for their services.