Pediatric Coding Alert

Question: I have a case where one physician (physician A) in my practice covered an established patient office visit for another physician (physician B) in the practice because physician B had to run across the street to see a patient in the hospital. They want me to bill the office visit incident-to physician B even though he was not in the office at the time. Is this legit?

Answer: You should not report this service incident to physician B.

Incident-to billing doesn't apply between two physicians. You cannot bill services provided by one physician under another physician's name or national provider identifier (NPI). Billing under the name of a physician who did not perform the service could lead to allegations of false claims submissions.

Incident-to billing may apply when a mid-level provider or non-physician practitioner (NPP), such as a physician assistant (PA), nurse practitioner (NP), or clinical nurse specialist, provides a service under the direct supervision of a physician. If the service meets incident to criteria, you can bill the service under the physician's NPI rather than the NPP's.

In this case, physician A should bill for the service.