Internal Medicine Coding Alert

Published on Tue Mar 16, 2004 PDF

Question: Do you have any tips for reporting a non-physician practitioner's service to Medicare when he works for an internist?

Oklahoma Subscriber

Answer: You should follow three rules for reporting "incident-to" services:

1. The supervising physician must be present in the office suite.
2. The nonphysician practitioner (NPP) must treat an established patient for an existing problem. For instance, the NPP provides follow-up care for a patient with cough- variant asthma (493.82).
3. The NPP must also follow the internist's treatment plan when caring for a patient. For example, the NPP treats a patient's hypertension (401.x, Essential hypertension) using the antihypertensive medication the physician prescribed.

If the physician and NPP do not meet these guidelines, you'll have to bill the claim using the NPP's unique personal identification number. Also, remember that the above requirements apply to Medicare patients. You should check with your private carriers for their rules for billing incident-to services.