Medical Coding | Difference of PA to a Physician | Chronic Gouty Acute Flare Code

Q #19: What documentation is needed from the PA and physician in a split/shared visit?

A: Really interesting here. It depends, first of all, I think with insurance companies, too. Medicare is really picky about PAs but they can do just about anything the physician is doing. The physician signs off on it. However, there are some things that it will only pay if the physician does it. Those are guidelines that you’re going to need to look up for the insurance company, not a coding question there; it’s more of a billing question.

Medical Coding | Difference of PA to a Physician | Chronic Gouty Acute Flare Code

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Let’s see, definitely both have to sign. Usually, what happens is the PA does the report, and he signs the report, and then the physician comes back and adds to the report and says “I agree.” He does a little run, review again, and says that he agrees with the plan of care of the PA, or endorses it, something like that. Again, he is a clinician. He is being overseen by the physician and his documentation is valid. So, you can turn in or use that, but each insurance company may have something particular that they want in documentation for a PA, or a physician’s assistant. I think it varies in state to state.

Q #20:  Chronic gouty acute flare code?

A: Well, what I would go to do that is I’d go to ICD-9 and I would look up “gout,” and then you’ve got chronic and acute. Unless there’s a code for chronic and acute, which I’m trying to remember off the top of my head, and I do believe that there is a code for chronic and acute. Or, you’ll code it as a chronic gout, but it’s an exacerbation is what I think the term that you’re probably looking for, and that will say that they have chronic gout but they’ve had an exacerbation, which means that they’ve had an acute flare-up.

Q #21: Can a PCP come see you at the hospital or surgery center, and if yes, what will he be on?

A: I assume this is a question on the report, or how does he get paid for that, and that’s a billing question. The PCP does come to the hospital a lot, and he will get paid for that, but he has to do a documented report, and he will do it through his office that he went and saw him, and that place is service code would apply here when you’re doing the 1500 form.

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