Wiki Incident to billing

[karenoakey@yahoo.com]

If a mid level provider is seeing a patient in an office setting for a know blood problems and presents with new abdominal pain..... Supervising physician is called into the exam room and determines patient needs to go to ER. Can this be billed incident to? If so, what documentation needs to be written?

 

[c_selinsky]

I think you need to code this a new problem with the appropriate modifier(s)

 

[amyjph]

There are other questions first. 1. Who is the payer - do they even recognize or accept incident to? 2. This would not meet the incident to concept if the physician personally saw and examined the patient in the office for this new problem. 3. Was the NPP providing all the care in the office and the supervising MD just did a "hallway chat" and said, "yes send them to the ED"? 4. Did the provider who sent the patient to the ED see them there in the ED, or did a separate ED physician? 5. Was the patient admitted to inpatient during the ED visit or sent home from the ED? If so, who admitted?

Depending on the documentation and the questions above this whole thing probably will not meet any incident to scenario. New problems do not meet the concept of incident to.

Edited to add: here is an example of an incident to decision tree: https://www.novitas-solutions.com/webcenter/portal/MedicareJL/IncidentTool#