Wiki Billing PA-C vs Dr. for IP Hosp consults

[mshaw530]

Could anyone help clarify when I would bill a PA-C vs the Dr. for a hosp consult?
I code for a Cardiothoracic surgeon who's PA-C will perform the consult and then the Dr. will be in later to see the patient and sign off on the med record.
But, I am coming across some where the consult note does not indicate the Dr. saw pt face to face, only that he is 'aware' of pt or has reviewed pt's chart and will make recommendations from that.

Can someone point me to where I would find what guidelines Dr. would need to follow in order to bill him for consult?

Thanks!

Mandi Balder, CPC
Cardiothoracic Surgery
balderma@mercyhealth.com

 

[dclark7]

The doctor would have to see the patient face to face and write his own note documenting his exam and findings. If there is no face to face then the consult must be billed under the PA-c. There are guideline in the Medicare Claim Processing Manual Chapter 12, Section 30.6.1. You would have to check with your other insurance carriers for their specific policies.