Wiki incident-to services

[clowe]

Patient was seen by Dr. Name on 1/21/10 and a plan of care was established for back and neck pain.

Patient returned on 2.15.10, for follow-up of back and neck pain and was seen by NPP.
NPP discontinued medication started by Dr. Name for back and neck pain.
NPP added new medication (Gabapentin and Tramadol) for back and neck pain.

Could this still be billed as incident-to since the NPP changed the plan of care?

No new problems were presented by the patient or addressed by the NPP.

NPP discussed med changes with Dr.

Please give reason for or against incident-to. Thanks.

 

[mitchellde]

I say no this is not incident to and should be billed under the NPP's NPI

 

[clowe]

Please share your reasoning to help me understand. Thanks.

 

[FTessaBartels]

Treatment plan

The NPP was changing the treatment plan, not simply following the patient for a treatment plan put in place by the physician. THAT is why the visit must be billed uder the NPP's name/number.

In order to be "incident to"
1) established patient
2) established problem
3) existing treatment plan

If any of the above is not met, the visit cannot be coded as incident to. (Medicare thinks "consultations" were abused?! THIS will be the next area CMS eliminates ...)

Hope that helps.

F Tessa Bartels, CPC, CEMC