Hi there, could you share a few links to what you have read about incident-to?
Some things to keep in mind:
1. The plan of care has to be established before the incident-to services begin.
2. The plan of care is what the person performing the incident-to services follows to treat the patient. So it must contain enough information to do that.
Thank you for responding.
I have read the Medicare Benefit Policy Manual chapter 15 section 60.2 and beyond. In addition, Medicare Billing guidelines and have also looked at AAPC articles, multiple forum posts, etc. I have exhausted multiple paths of research. There are VERY clear guidelines when a Therapy Plan of Care is established, but seemingly none related to the clinic setting and having a QHP carry out previous orders. Here is an example documentation from one visit:
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NP documents HPI, Exam, A/P sections.
This is an established patient who was last treated with injection for her OA in the right knee 5 years ago.
Contribution of MD:
"X was seen in conjunction with the NP today. I refer the reader to that note for full details of our interaction. It should be noted that I established a plan of care. We provided a right knee injection which was performed by the NP. We would see X back in this clinic at any point in the future at her discretion. All questions were answered."
NP states in A/P:
"X is a **-year-old female with right knee osteoarthritic pain and dysfunction.
Radiographs and biomechanics of condition reviewed with patient.
Conservative versus surgical treatment options discussed. Total knee arthroplasty is the definitive surgical intervention.
X would like to exhaust conservative treatment options prior to proceeding with surgical intervention.
I recommend OTC to relieve pain.
Corticosteroid injection discussed. Injection given as above.
Continue weightbearing and activity as tolerated.
RTC as needed.
This is a **-year-old patient who is new to Dr. V with right knee pain. Dr. V saw the patient today and the plan of care was established which will be carried out by myself (NP) today. Dr. V was immediately available in the orthopedic clinic today."
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I need to know if this would be considered an acceptable method of documenting for this situation. To me, this is less than ideal in establishing a Plan of Care. However, this provider is also not very receptive to changing their ways and I will need a compelling argument to get them to change. I would personally like to see this in the record:
Plan of Care established on XX/XX/XXXX by Dr. V to include injection of Kenalog for OA of the right knee. This treatment is expected to achieve pain relief and may be repeated up to every 3 months. Patient may follow up as needed.
