By Tricia Marriott
Global Visits:
Work that must be done and would otherwise have to be handled by a physician if the practice did not employ Physician Assistants.
The problem with global visits for the PA:
Unfortunately, global visits have no monetary value. By performing the global work, the pa enables a physician to schedule revenue-generating encounters, such as new patients, consultations and procedures, in time slots that would have been otherwise closed out by the non-revenue-generating global visits.
Tracking Global Visits:
Global visits are designated by CPT code 99024 and typically are not included in the billing system because they do not generate a bill. By putting 99024 into the billing system, the office can track the volume of those visits for each provider. If, for example, at the end of the fiscal year, the pa has handled 500 global visits and the physician has handled 20, you might be able to extrapolate that the pa enabled the physician to cover 480 revenue-generating encounters. Another way to look at it is to take those 480 encounters, split the revenue for the encounters in half and attribute 50 percent to the pa, subtracting 50 percent from the physician’s revenue line. Remember, if the pa had not seen those patients, the physician would not have had open slots for the new patients/new problems/consultations. the pa’s work contributed to the physician’s revenue numbers.
Calculating Global Visits:
Medicare fee breakdown
11 percent for pre-op work
76 percent for intra-op work
13 percent for post-op care
Thus, 24 percent of the global payment is for non-OR services. Confused? Let’s look at the example of a total knee (27447), payable at $1,769, with the final figure affected by the geographic index).
Here’s a breakdown of the payment when the above formula is applied, with the final figures affected by geographic index:
Pre: $194.59
Intra: $1,344.44
Post: $229.97
If a pa does the pre-op exam and post-op global rounding/office visits, $424.56 could be “credited” or “allocated” to the pa. a separate payment of $240.58 could be officially credited to the pa for the first assist (13.6 percent of a surgeon’s fee). a true measure of pa “value” might be a first assist payment of $240.58, plus a share of the global payment of $424.56. That’s a total of $665.14. If you are using claims data only, it is still difficult to get at the office e/M performed by the pa when it is billed under the physician’s name. Tracking encounters, CPT codes, and RVUs by provider can help mitigate that hole in the data. Applying these concepts can help physician pa teams assess the pa’s contribution to the practice.
TRICIA MARRIOTT is the director of reimbursement policy for AAPA.