Wiki PA billing guidelines in an urgent care setting

[PKOHUT]

Can our physician assistants see patients in the ER on their own or does one of our physicians need to be there as well? What would be the incident to guidelines in this setting?

 

[thomas7331]

Can our physician assistants see patients in the ER on their own or does one of our physicians need to be there as well? What would be the incident to guidelines in this setting?

Can they see patients and how they can bill are two different questions - I'll try to answer these separately.

1) Whether or not a PA can treat a patient and what the supervision requirements are will depend on the scope of practice laws in your state - you would need to contact your state's licensing board to get the answer to that. Normally it's outside the scope of a coders job to decide whether or not a provider can see a patient and whether or not the physicians needs to be present to supervise.

2) 'Incident to' means acting as an 'extension' of the MD, which allows for billing the PA's services under the physician's credentials, which really has nothing to do with the first question of who the PA can see. The PA can bill under the physician's credentials if PA is an employee of the physician and is practicing under supervision and at an office location that is owned by that physician. So if this is an urgent care center that is fully owned by the physician(s) and one of the owner MDs is on site to supervise the PA, and the PA is seeing the patient for an established problems and carrying out the physician's plan of care, then it can be billed as 'incident to'. Otherwise, if the ER or urgent care center is part of a facility, or is a location that is not owned by the physician, or if the PA is treating a new problem for which the MD has already written a plan of care, then it cannot be billed 'incident to' and the claims must be billed under the PA's credentials, not the physicians.