E/M Coding Alert - 2005 Issue 5
You Be the Coder: How Should You Bill for PAs in the ED?
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Article Overview
This Q&A article addresses billing in the emergency department when physician assistants perform procedures and physicians are involved in related care. It focuses on Medicare rules for shared encounters, provider identification for separately reported services, and the practical difference between Medicare and private payer policies. The discussion is intended for coders, billers, and revenue cycle staff working with ED professional claims.
Why This Topic Matters
Correct provider attribution in the emergency department affects claim accuracy, compliance, and reimbursement. The article helps readers understand when shared E/M billing concepts apply and when services performed by mid-level providers must be tracked separately under payer-specific rules.
Article Sections
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Question
Introduces the billing scenario involving emergency department procedures performed by physician assistants and asks what documentation is needed for claim submission.
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Answer
Explains the general Medicare approach to shared encounters and separately reported services in the emergency department. It also notes payer variation and the need to verify individual carrier policies.
What You Will Learn
- How emergency department professional services are treated when more than one provider is involved
- The difference between shared evaluation and management billing and separately reported procedures
- Why Medicare and private payer policies may not follow the same approach
- What types of documentation and provider attribution issues are relevant to ED claims
Who Should Read This
- Medical coders
- Medical billers
- Emergency department billing staff
- Revenue cycle professionals
- Practice managers
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