Pediatric Coding Alert

If you automatically report under your NPP, you're costing your doc 15%.Being able to report an "incident-to" service when a qualified non-physician practitioner (NPP) provides care means you can file the claim under the physician's National Provider Identifier (NPI) instead of the NPP's. That allows 100 percent reimbursement for the codes you submit instead of the usual 85 percent reimbursement for claims filed according to Medicare guidelines under the NPP's NPI. More private payers are adopting this same policy, so check with your payer and remember three things to ensure you're following guidelines correctly.1. Check the Plan of Care The first rule for incident-to billing is that the pediatrician must see the patient during an initial visit andestablish a clear plan of care. These care plans can address issues ranging from asthma (493.00, Extrinsic asthma; unspecified) to chronic serous otitis media (381.10,Chronic serous otitis media, simple or unspecified) to infant [...]