Wiki Incident to or Direct Bill situation

[cvand1972]

Established patient has been followed in the office for A-Fib. Patient now presents for Chest Pain. Nurse Practitioner sees alone (with no MD). Would this be Direct Bill??

 

[LLovett]

Chest pain would be a new problem, I'm guessing, so it would not qualify for incident to. This should be billed under the NP.

Laura, CPC, CEMC

 

[VRock]

Is there a plan of care in the physician's note? Is the NP working it up as a new problem? My inclination is to direct bill.

 

[cvand1972]

There is no physician note in reference to the Chest Pain visit, just the NP's note.
I was stumped on this one because Chest Pain is a symptom of A-Fib. So.. if the patient is already being followed for A-Fib, then the Chest Pain could be related to that previous condition of A-Fib and they should be able to bill 'incident to'.
On the other hand, chest pain is related to several things.....

 

[LLovett]

Chest pain could be related to any number of things, if the patient is coming in for an acute episode, I would not consider it incident to.

Laura, CPC, CEMC

 

[cvand1972]

That's exactly what drew me away from 'incident to', but I needed to 'talk it out'...

Thank You.