Wiki physician assistant billing

[duerheimergm]

one of our PA's attended the Annual AAPA conference and the lecturer stated,"Existing patients with NEW conditions can be billed as a level 4." Is there any accuracy to this statement?

any help will be appreicated
thank you,
Gerri Duerheimer, CPC
Virginia

 

[lostone65]

I'm a little confused about your question. If you mean a level 4 established patient 99214, then it can be billed as long as the office visit meets the level criteria. If you are talking a level 4 new patient visit 99204, then it can only be billed if the patient has not been seen in your practice by any of your physicians in the last 3 years and meets level 4 criteria. i am not sure if that is what you were looking for.

 

[code4you123]

PA coding

Established patients with new problems should not be seen by the PA, CMS requires the MD must see these patients. Reference, "Incident to" Medicare Part B payment policy is applicable for office visits when the requirements for "incident to" are met (refer to sections 60.1, 60.2, and 60.3, chapter 15 in IOM 100-02).

As for the level IV coding, documentation and medical necessity is required to support the E&M level IV services, new problem or not. Reference the CMS billing manual; 30.6.1 - Selection of Level of Evaluation and Management Service, for more information.

 

[TamaraM]

PA billing level 4's

Is the question simply that a PA can code a level 4 office visit??
If so -yes we have a PA in our office and as long as he meets the criteria for a level 4 we bill it.

 

[RebeccaWoodward*]

one of our PA's attended the Annual AAPA conference and the lecturer stated,"Existing patients with NEW conditions can be billed as a level 4." Is there any accuracy to this statement?

any help will be appreicated
thank you,
Gerri Duerheimer, CPC
Virginia

Gerri,

For the purpose of Medicare:

Depending on state law/scope of practice, a PA can see an established patient with a new problem; however, the claim must be submitted under the PA's identifying information. "Incident to" would not be applicable in this situation. As for coding a 99214, if you have met the qualifying components along with medical necessity, it's possible to justify this level.

Section 190-

http://www.cms.gov/manuals/Downloads/bp102c15.pdf