Wiki PAs and consults?

[nrichard]

I'm getting caught up on the verbage in CPT about consults. “A consult is a type of evaluation and management service provided by a PHYSICIAN at the request of another physician or appropriate source” I interpret it to mean only a physician can perform the consult, but other providers can order a consult. The reason I ask is because I'm wondering if I can bill a consult for my PA or do I need to report subsequent hospital care codes. Since she didn't admit the patient I know I can't bill for the initial hospital care codes. Thanks in advance.

 

[kbarron]

As far as office visits go, Consults are not paid by Medicare. That said, some of the other insurances do pay consult codes for Midlevel practioners. I have just done research on this subject as I believe money could be lost because of the CMS rule.

 

[Sueedwards]

I agree with Karen.... I would try with the PA to submit the consult and see what happens, the PA did the work and you have the documentation...
thanks, Sue

 

[wkc12981]

I'm getting caught up on the verbage in CPT about consults. “A consult is a type of evaluation and management service provided by a PHYSICIAN at the request of another physician or appropriate source” I interpret it to mean only a physician can perform the consult, but other providers can order a consult. The reason I ask is because I'm wondering if I can bill a consult for my PA or do I need to report subsequent hospital care codes. Since she didn't admit the patient I know I can't bill for the initial hospital care codes. Thanks in advance.

Actually, at least in my state, you can bill an initial hospital care codes because your admitting physician should have put an AI modifier on his initial hospital care code to indicate he/she was admitting physician.

-AI Principal physician of record (Use this modifier to identify the the admitting physician of record who is overseeing the patient's care. This modifier will be used to distinguish between the admitting physician and other physicians who may be furnishing specialty care. The admitting physician will append this modifier to his/her initial hospital or initial nursing facility care.)