Otolaryngology Coding Alert

Question: Will the new National Provider Identifier (NPI) change how we report services incident-to?


North Carolina Subscriber


Answer: No. The CMS-issued 10-digit NPI number will replace the current identifiers that carriers use, such as the provider identification number (PIN) and the unique provider identifier number (UPIN). But the change will not affect your incident-to coding.

You will simply report a service incident-to using an otolaryngologist's or nonphysician practitioner's NPI, instead of his current identification number.

Example: After an otolaryngologist orders a patient to return in a month for a recheck of her nasal ulcers, a nonphysician practitioner checks the patient's nasal tissues. The NPP who is performing the E/M service incident-to the physician's plan of care recommends that the patient discontinue nasal steroids, use an over-the-counter nasal gel and return in another month.

When your physicians or group obtain their NPIs, you'll report 99212-99215 (Office or other outpatient visit for the E/M of an established patient ...) incident-to the on-duty ENT's NPI with the ulcer diagnosis, 478.1 (Other diseases of nasal cavity and sinuses).