Wiki Physician's assistant with MD supervision in hospital

[wynonna]

If an ENT MD does a consult with everything other than a History and ROS gathered and dictated under a hospitalist Physician's Assistant, is it billable under ENT MD because hx/ROS is being done under ENT supervision? And ENT MD is doing exam and MDM and reading PA notes for history and exam.
For an interim visit AND
How about in the case of an initial visit?

thank you

 

[csperoni]

You indicate the PA is not part of the MD ENT's group. The MD can only get credit and bill for shared services provided by PA/NPs that are employed by the same group. If the PA is employed elsewhere, someone else is billing for those services. Your MD would need to review and confirm the history (and document such) in order to receive credit for it.

Here are some guidelines about split/shared inpatient billing. It is specified the physician and NPP must be part of the same group practice.
https://www.novitas-solutions.com/webcenter/portal/MedicareJL/pagebyid?contentId=00081589

So for initial visit (or consult if requirements are met), all 3 elements of hx, exam & MDM are required.
Subsequent visits require 2 of 3 elements.
It would seem if hx is not done, initial visit is not billable (unless meet requirements to bill on time). Subsequent visit could be billed on only the exam & MDM done by MD.