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Wiki 2021 E/M OP guidelines

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BonnieJ123

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Two basic questions:
What happens to incident-to for office with the new 2021 E/M codes if time is used as the first visit when the physician follow ups after the PA on the same encounter?
Is this for Medicare patients only?
 
I don't understand what you are saying. What do you mean by "when the physician follows up after the PA on the same encounter"? For incident-to, there is no split or shared service, so there is no "same encounter." The doctor sees the patient for the first visit and for any new problems, then the PA follows the doctor's plan of care.

This is not Medicare only.
 
No, sorry I didn't explain well enough. The same encounter would be the first office visit whether NP or new problem where the PA may see the patient first and then the doctor steps in(per incident-to guidelines). So if both are seeing patient same encounter would it be incident to or billing by time if time kept correctly? Also, are the new 2010 OP guidelines for Medicare only patients or all commercial insurances too?
 
You cannot bill incident-to on the first visit, or for a new problem, so the PA would not be seeing the patient in either of those two scenarios. There are no "incident-to guidelines" as you said, that state that has to occur. In fact, you wouldn't need incident-to if the MD were seeing the patient every time.

If you are talking about followup visits, then the MD doesn't need to see the patient for incident-to.

When we had a PA, rarely would both the MD and the PA see the patient on the same day. It usually only happened when the patient's condition had worsened greatly since their last visit, and the PA would ask the doc to come see the patient in the room. Then you would add the time together for both. But in both of your posts, you are describing both providers seeing the patient as a matter of course.

Also, as I said, the new E&M is not only for Medicare. It is changes in the CPT codes put out by the American Medical Association, so it applies to anyone who uses CPT codes.
 
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