gout flare up

q #19: what documentation is needed from thepa and physician in a split/shared visit? a: really interesting here. it depends, firstof all, i think with insurance companies, too. medicare is really picky about pas butthey 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 guidelinesthat you’re going to need to look up for the insurance company, not a coding questionthere; it’s more of a billing question. 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 physiciancomes back and adds to the report and says “i agree.” he does a little run, reviewagain, and says that he agrees with the plan

ofcare of the pa, or endorses it, something like that. again, he is a clinician. he isbeing 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 documentationfor a pa, or a physician’s assistant. i think it varies in state to state. q #20: how do you code chronic gouty acuteflare? a: well, what i would go to do that is i’dgo to icd-9 and i would look up “gout,” and then you’ve got chronic and acute. unlessthere’s a code for chronic and acute, which i’m trying to remember off the top of myhead, and i do believe that there is a code

for chronic and acute. or, you’ll code itas a chronic gout, but it’s an exacerbation is what i think the term that you’re probablylooking 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 hospitalor 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 thehospital a lot, and he will get paid for that, but he has to do a documented report, andhe will do it through his office that he went and saw him, and that place is service codewould apply here when you’re doing the 1500

form.