incident to

  1. T

    Wiki Plan of Care for Incident To Visits

    In the RHC Orthopedic Clinic setting, when performing an "incident to" visit, what are the requirements related to the establishment of a Plan of Care? I have been unable to locate any specific information from Medicare regarding the minimum information necessary. This is not P/O/S therapy...
  2. M

    Wiki incident-to drug screens question

    One of our providers only works remotely and sees all his patients through telehealth. He sees patients who are going through treatment for opioid addiction. This requires the patients to come into the clinic and have drug screens performed by the medical assistant. Since this provider is never...
  3. T

    Wiki Incident-To Billing for new PA

    Hello, We have a new physician assistant that joined our group. We are waiting on her credentialing to be finished up with several payers. If the supervising physician is on-site and incident-to requirements are met, and the supervising physician is in network and credentialed with a payer...
  4. M

    Wiki Injection given in patient's home

    The office I work for (outpatient behavioral health) is planning to start having nurses go to patient's homes to administer psychiatric medication injections. Is this billable as "incident to" since the provider is not in the building where the patient is having the injection done? If not, is...
  5. K

    Wiki Pharmacist Options - CHC

    I work for an FQHC/CHC and they are trying to catch missed revenue. I know a Pharmacist only encounter is 99211 (nonbillable in our setting). However, if they implement a process where the Pharmacist initiates the visit like a RN would and then leaves the MDM to the provider for completion...
  6. K

    Wiki Incident-to

    For incident-to, would you bill an APP's services under the physician who started the patient's treatment plan, or under the supervising physician who is available in the office at the time of services. Thank you!
  7. M

    Wiki Billing for RN services with no supervising provider in the office

    I work in an outpatient medical and mental health clinic with 2 locations. My location is mainly admin staff and social workers. We do have an ANP and an RN at this location, but the ANP is moving his office to our other location. The problem is that the nurse wants to remain here and continue...
  8. baroquecoder

    Wiki Weight Check 99211

    Chief complaint: weight check ordered as incident to service provided by nurse; 99211 assessment plan: patient is gaining weight appropriately. Come back in 2 weeks for weight check newborn. Z00.111 is the code used. Does this meet the guidelines for incident to reporting? Weight check is...
  9. B

    Wiki LCPC billing under LCSW to Medicare

    I have an LCPC who would like to bill under an LCSW in IL to Medicare for psychotherapy services. I don't think this is allowed, but I cannot locate the information online. Can anyone help?
  10. F

    Wiki Billing for non-credentialed Nurse Practicioner

    We have a new NP that is not yet credentialed with all payers (only MCR and MCD). The physician wants to bill everything under his NPI. Not all of the encounters meet incident to requirements, some are new patient visits or new chief complaints. Also, not all payers go by MCR guidelines on...
  11. K

    Wiki Can PAs and NPs see a NEW Medicare Patient?

    Hi there, I work in a Dermatology practice and there has been some discussion over billing for PAs and NPs... I'm wondering: Can PAs and NPs see NEW Medicare Patients? Thanks!!
  12. O

    Wiki NP in Credentialing Process

    Can anyone give me some advice on if we are in compliance by allowing our NP who is in the process of being credentialed(apps already submitted) to see the patients on her own without the provider going in the rooms with her but who is readily available to answer any questions she may have...
  13. N

    Wiki In Urgent Care setting, Can a Physcian Assistant bill a new pt using his/her own NPI?

    Hi coder family:) I guess my question is can P.A's see new patients in Urgent Care? I am auditing our P.A.'s who see patients Monday-Sunday in Ortho Urgent Care. My question is, if a new patient comes in to be seen and a P.A. see's them for the first time. Would the P.A. be able to bill...
  14. K

    Wiki Help! Nurse practioners and xrays incident to?

  15. M

    Wiki Doctor in the suite documentation

    Our nurse practitioners are seeing patients for more than one doctor during the day. Does it have to be the NP to document which physician is in the suite? Can the ancillary staff documents that the patients doctor is in the suite and available for consultation and the NP review the comment...
  16. J

    Wiki Billing Medicare for NP services in an outpatient rehab hospital

    I have run into a situation with a NP doing Botox injections for spasticity in POS 22. First, am I right in thinking that it is not appropriate to bill Medicare incident to in POS 22 even if there is a supervising physician? Right now we are billing using just the NP NPI and CPT code 64642 is...
  17. R

    Wiki Incident to billing scenario

    A nurse practitioner sees a Medicare patient for the initial visit and sets up a treatment plan, billing under them at 85%, because there was no supervising physician on-site. The patient returns for a second visit to see the nurse practitioner, but this time there is a supervising physician on...
  18. B

    Wiki Incident To - Billing/Rendering/Supervising

    Hi folks. Hope you can help me out with some incident to info. I have an NP and a supervising physician that work together. They each have their own schedules. The supervising physician and the NP both always sign the progress note for each patient the NP sees. What I'm trying to figure out is...
  19. D

    Wiki RN Limitations

    Is anyone familiar with billing for RN services such as: Catheter or PICC line placement and being paid for it ? Obviously if it is submitted under the Physician's name, one would conceivably be paid for it. On the other hand, since the Physician may have been present, but didn't ever assist...
  20. J

    Wiki Denials for Subsequent Hospital Care (99231 - 99233)

    Hello, Our billing team has been receiving denials from several payers on our Subsequent Hospital Encounter claims (99231-99233). The denials we receive state something along the lines of the code being incident to the primary procedure code or being bundled. Per the CPT book these codes are to...
  21. U

    Wiki Incident To

    Practice I work for is bringing on a provider (MD) who is licensed in New York moving to Illinois. As we await credentialing, we were looking to bill incident to for this MD under the attending (IVF Clinic) . We understand the rules for the E+M and treatment plans to be managed by the...
  22. J

    Wiki Billing NP Incident to a Locum Tenens Physician

    Knowing that the Locum Tenens provision does not apply to mid-levels, does anyone have an answer for the following scenario? Practice with 2 physicians, 1 NP, 1 PA. Currently bill NP and PA charges as "Incident to" the physician in the office at time or service. One physician is leaving...
  23. B

    Wiki Diabetes Education as Incident To

    We are a multi specialty practice providing Diabetes Education by RD's. Would you ever bill out DM Education CPT codes 98960, 98961 & 98962 (which are non-physician professional codes) as incident to with the M.D. as the supervising physician?
  24. A

    Wiki incident to question

    Brand new doctor out of residency is coming to the practice. The current physicians want to know if they can bill for services performed by the new doc under the incident to rules until she is credentialed and can bill as a participating provider herself. I have my own thoughts on that but...
  25. S

    Wiki Incident To Rules and the WWE

    I have researched this without success... "Incident To" guidelines state that the physician must personally treat the patient on the patient's first visit to the practice or treat any established patient who comes to the office with a new medical condition. NPPs may provide follow-up care. How...