Physicians Practice - June 2008 - (Page 52) ASK THE EXPERTS PAs AT WALK-IN CLINIC SUPERVISED BY SURGEONS Q We are considering opening a walk-in clinic in our building that would be staffed by an internal medicine physician assistant (PA). The clinic would handle patients with one-time minor issues such as cuts, bites, sore throats, etc. We currently employ six PAs in our surgery practice and realize their capabilities. The plan would be to make it an extension of the current practice, therefore not under a separate tax ID. Are there any legal issues with general surgeons supervising such a practice? other disorders of the external ear. The fifth digit designates whether the condition is acute or chronic. VAGUE DOCUMENTATION HURTS SKIN LESION CODING Q How would you code the following: “Attention was paid to a 6mm diameter cystic structure of the right anterior neck region. A skin marking pencil was used to draw a dotted line around the periphery of the lesion as well as a proposed excision of a fusiform wedgeshaped area of skin over the mid portion of the cyst was added to closest to the skin, the excision of skin measuring include partial or full thickness damage to the skin and/or subcutaneous tissues, which is all that is mentioned in your note. Intermediate repairs include deeper layers of the subcu and nonmuscle fascia. BONUS TO EMPLOYEES WAIVING HEALTH BENEFIT Q What if an employee asks for more salary instead of taking a health premium? A Well, you can provide an option for a one-year bonus, but you are not required to. This is a benefit you offer out of the goodness of your heart and a desire to retain employees. If an employee doesn’t want it, so be it. If you decide to pay the cash, you’ll need to offer it to everyone who opts out of the program, not just one employee. And I’d suggest you set this policy at open enrollment when everyone truly does have a choice, instead of mid-year. You would also want to make it very clear that this is a one-time payment, reflecting their decision to opt out of the program, not a raise in salary. If they opt in next year, bye-bye increase. You should also do some quick math, looking at the tax consequences of adding salary versus benefits. I’d also suggest talking to your insurance rep. If you offer this option, more employees may decide to not get insurance, which is an ethical issue, certainly, but also a financial one since most plans get very expensive when you have fewer and fewer employees. WELCOME TO MEDICARE EXAM What’s relevant, then, is whether your surgeons are up for supervising and reviewing the work of PAs dealing with sore throats and the like. CLINIC CONSIDERATION A Broadly speaking, physician assistants should act under the supervision and delegated authority of the physician. What’s relevant, then, is whether your surgeons are up for supervising and reviewing the work of PAs dealing with sore throats and the like. They may be well out of the loop on current guidelines for nonsurgical issues, or may not be. You’ll just need to consider this. Checkout what your state licensing board has to say about PA supervision. You also will want to call your major payers and confirm that they would cover claims submitted from your tax and payer ID for such services in such a setting. This isn’t a legal concern, exactly, but a contractual one and you best make sure you’ll get paid before you proceed. ANTIHELIX LESION approx 1.8cm x 0.3cm, the subcutaneous tissues and dermis were approximated through the use of interrupted sutures 5-0 chromic catgut, skin edges approximated through use of running sutures 6-0 nylon.” So how would I first code the excision? Should I code the 6mm size or the 1.8cm size? And shouldn’t it mention the size of the repair? Intermediate or complex? Q What ICD-9 would I use for antihelix lesion? A Please review the codes in section 380.00. These can be used for chondrodermatitis nodularis helicis and 52 | PHYSICIANS PRACTICE | JUNE 2008 A First, it would be well worth your time to go back to the physician and educate her on what she should make absolutely clear in the documentation to avoid confusion in this case and future ones. It’ll save you both headaches in the long run. If it is impossible to get clarification, you are forced to code what IS documented. So for size, as I understand your excerpted note, the key phrase is: “the excision of skin measuring approx 1.8cm x 0.3cm.” Again, without clarification we are forced to assume a simple repair. According to CPT, simple repairs Q We are just now starting to get patients from Medicare for their “Welcome to Medicare Exam.” I have heard that it is difficult to get these exams paid if you don’t use specific coding. However, I am unsure as to what the correct codes are. Can you help me? A You need to use G codes. Here are the basics of what is required and how to code: WWW.PHYSICIANSPRACTICE.COM http://WWW.PHYSICIANSPRACTICE.COM
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