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Lisa Bledsoe

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I am straining my brain and the more I read the less I know. Question: NPP in multi-specialty group practice performs PFT's prior to the patient seeing the pulmonologist (as a new patient). The NPP's supervising physicians include the PCP who referred the patient (established to him) to the pulomonologist, the ENT specialist, and the pulmonologist. Can the PFT's be billed incident to?
 
Pardon my ignorance, but what is a "PFT"?

Whatever it is, the NPP can't bill incident-to the pulmonologist because the pulmonolgist has not seen the patient yet. The NPP may be able to bill incident-to the PCP, as long as the "PFT" is part of the treatment plan established by the PCP. Does that make any sense?
 
PFT = pulmonary function test.
The patient was referred to the pulmonologist who requests PFT's prior to seeeing the patient as it is part of his "diagnostic process". He is the one who signs off on the PFT, so I'm pretty sure it can't be incident to...I just can't stop going in circles. I read something from CMS about certain diagnostic tests could be billed incident to, but I can't find a list of these anywhere. The CMS website is so easy to find stuff on, ya know?
 
Yeah, I know! LOL

There may be such a list, but you would still have to follow all the other "incident-to" rules, and I don't believe this situation qualifies since the pulmonoligist has not yet seen the patient. You can get around this by having the PCP order the PFT and billing the NPP "incident-to" him/her.
 
To be incident to Walker22 is correct, the PCP must be the physician that orders the test and has included it as a part of his plan of care, so if the Pulmonologist is the one that wants it and signs off on it then this cannot be incident to the PCP and since the Pulmonologist has never seen the patient then it cannot be incident him either so it must be bill under the NPP number.
 
Thanks Debra. I was pretty sure that was correct, but the more I thought about it the more I confused myself...I was realy over-thinking the situation!
Happy Holidays!
 
PA supervised by ENT: patient has cerumen impaction in September treated by ENT MD. Comes back in December with cerumen impaction and sees PA. Is this incident to? I think not because it is a new occurrence of cerumen impaction.
 
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