Pain Management Coding Alert

Published on Tue Jan 09, 2018 PDF

Question: We have two house-call teams of advanced practice nurses (APNs) who go to patient homes along with their licensed practical nurse (LPN) to see patients with chronic problems unable to come to the physician's office. They also see patients within 48 hours of their hospital discharges to help avoid readmissions. Although the APNs work under the supervision of the physician and the physician determines the initial care plan, can the visit be coded incident-to since the physician is not present at the home visit?

Colorado Subscriber

Answer: Unless the physician goes to the house with the APN, the home visits are not reportable as incident-to. According to the incident-to rules, there needs to be an established course of treatment and the physician must be physically available in the office suite, or area of treatment, at the time the APN renders the service. Thus, a home visit without the physician would not be eligible for incident-to billing.

These should be billed directly under the APN's national provider identifier (NPI). These are certainly reimbursable with only a 15 percent discount. 

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