Wiki Joint Inj's, PA's and Medicare

[caskln1]

We are a large Ortho practice for which our PA's do joint injections during E&M visits and we submit the claim under their name with the Provider as supervising. These are billed with the appropriate E&M if warranted, mod 25 if necessary, the 20610 CPT code and the drug. Now I'm being told by our Medicare rep that Medicare has been denying the PA's as there in no AS-80 modifier attached to the 20610 since it's a surgery code......Am I missing the boat here and that's how it should be coded for a PA and the 20610 during an office visit? Help please!!

 

[mitchellde]

it is not an AS modifier it is an SA modifier and if the PA is seeing the patient and making the determination to do the injection then you cannot bill under the physician for this, if the physician has in fact already examined the patient for this problem and the patient has returned for a second injection then you cannot bill an E&M. You must follow incident -to guidelines. If the patient has a new problem for an E&M then you still cannot bill under the physician as it does not meet incident-to. If the PA is not credential with Mcare then all visits must be incident-to, and must meet the definition as set forth my Mcare.

 

[caskln1]

Thank you Debra, your reply helped, the SA was what I'm looking for. P.S. I enjoy reading your threads and find them very informative!