Wiki Physicians Assistant with Modifier 25

[sadieandbrian]

Wondering if anyone can help me or provide me any links/back up to a question we have in our office...

We do billing for a pain doctor (injections, etc). He has a PA that is seeing his patients in the office clinic setting, determining if an injection or what injection needs done...and then the PA is sending the patient over to the hospital to have the physician do the injection...on the same date of service.

Is the PA's office visit billable separately from the physicans procedure?

Thanks in advance, any feedback is appreciated.

 

[Cmama12]

Yes, the PA would bill (if insurance is commercial then may need to bill under supervising MD )an E/M with a 25 mod and the dr bills out the injection.

 

[sadieandbrian]

Thank you for the reply...so bill an E/M with a 25 modifier, even though the visit is not "signifcant, separately identifiable..." per the modifier 25 rules. (PA seeing patient for the same reason/diagnosis as the procedure being done)