Wiki Incident to/direct billing

[ktress]

Hi, I need help our office has question concerning Incident to /direct billing, I have an example if anyone can give me an answer I would really appreciate it. Patient presents to the office for a visit with a NP/PA ,patient has diabetes ,hypertension., patient now has an ulcer on their toe. Now patient has a new diagnosis of diabetes with ulcer. Is this a new diagnosis or a follow up to diabetes? Does this constitute a new diagnosis? therefor would this be billed as Direct or incident to? How would Medicare guidlines define this?

 

[FTessaBartels]

New problem

You say ... patient has diabetes ,hypertension., patient now has an ulcer on their toe. Now patient has a new diagnosis of diabetes with ulcer.

I'd say this is definitely a new problem, so I'd go with direct billing. The physician can't have formulated a plan of treatment for a problem that didn't exist before. (i.e. the ulcer).

Just my opinion.

F Tessa Bartels, CPC, CEMC

 

[ktress]

Thank you, Katie