Wiki Incident-to

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Good Morning,
I’ve posted a previous question on this same topic, but hoping a different take on it might produce some replies.
I have a couple questions concerning incident-to billing in an Urgent Care setting. First, is it appropriate to code for incident-to billing in an Urgent Care setting?
If it is appropriate, I have a couple of Urgent Care scenarios that I would like a sanity check on.
  1. Physician sees pt with impacted cerumen. Nurse performs ear lavage. Should 69209 be billed for the physician?
  1. Physician sees pt for urinary retention with indwelling urinary catheter. Nurse performs catheter change. Should 51702 be billed for the physician?
Any advice, guidance, and resources are gratefully sought.
Thank you,
Laura
 
Yes, if all of the 'incident to' requirements are met, then these services can be billed under the physician's credentials.

I guess the main concern I would have in the urgent care setting is whether it is a stand-alone practice owned by the physicians or if it is part of a facility because 'incident to' billing requires that the staff performing procedures be employees of the physicians. If this is a facility, and you're billing a facility claim separate from the physician claims, then you can't bill those services as 'incident to' a physician's service on the professional claim, but you can include them as a line item on the facility claim. But if it's a physician-owned practice, then the usual 'incident to' rules will apply.
 
Thomas,
Thank you so much. Your explanation is how I was understanding the incident to, but just couldn't find it plainly spelled out like that.
Thank you again,
Laura
 
I have a question about billing incident to.
For physical therapy service billed incident to, what are the documentation requirements? Does the therapist and the physican need to sign the note?
 
Most importantly, for incident-to billing, there must be a treatment plan in place for an existing condition, which is what the employee provides, incident to the physician. It's not just the 'supervision' of an employee that is the criteria for incident-to billing. Since most urgent care providers see new patients with new problems, and there's no treatment plan in place by the patient's provider, incident-to would rarely be peformed in urgent care (for Medicare patients). There are different billing rules for commercial payers, whereby a midlevel can bill under a supervising provider, but it varies by carrier.
 
Like to tag on to this post please. Question on incident to also.

RN see's an established patient and changes out an existing J-Tube. Physician is in the office suite. They want to bill CPT code 49451-52 since the RN does not do a report, nor fluoroscopy. I went against it and said the only think they can bill is 99211 with the HCPCS code for the J-tube unless the patient is supplying his/her own tube. Am I correct with my statement? I feel that billing 49451-52 is going to cause high risk.

My second part of the question is, they feel that they can bill 49451 and the RN do it because it falls under incident-to. My thoughts were only a NPP can perform services under incident to. An RN is not considered a NPP. Thoughts?
 
An RN can't report the J tube change, and that would also be an inappropriate use of the -52 modifier. You're correct. Why won't they listen to the certified coder? 😃
 
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