Incident to billing for complication of existing problem

[CatchTheWind]

Can we bill incident to if a PA sees a patient for a complication of an existing problem? Example: The doctor performed excision of a basal cell carcinoma. The patient returns (outside the global period) and sees the PA because the wound site is infected. Although now there is a different diagnosis (infected wound), it is follow-up care for the problem that the doctor has been treating. Is this incident to, or a new problem???

 

[dclark7]

You can only bill incident to if the PA is following a treatment plan established by the MD. Since this is a complication there is no treatment plan, it's a new problem that must be addressed.

 

[lhardin0621]

I agree. The infection would be considered a new problem .