Charleston, WV
Best answers
Hello Everyone! 🙂

According to what I have read (in regards to incident-to billing), in order for a patient to be seen by the PA and still be billed under the doctor, the doctor must do the following:
1) Initiate the treatment
2) Continue to be "actively involved" in the patient's case/ plan of care.

QUESTION: How often
must the physician see the patient (and document in the chart) to be considered actively involved? In other words, is there a more specific quantitative measurement of time, rather than a qualitative one?

  • During an initial visit, a patient is evaluated by a physician and is found to have osteoarthritis of the right knee. The doctor performs an injection into the knee and says he / she will see the patient on an "as needed basis."
  • During the follow-up visit, three months later, the patient is seen by the PA, who continues with the same plan of care for the same diagnosis and injects the right knee.
  • The patient returns to the office 1 year later with the same diagnosis and requests a repeat injection into the right knee. At this point, Must the doctor see the patient and document in the report? If not, How about in 2 years? 3 years?

Thank You in Advance! 🙂
There is nothing specific that I am aware of, only that services have to be provided by the doctor on a frequent enough basis to demonstrate his continuing active participation in the patient’s care.
I would call this a grey area, but a year later with additional services, I would not consider an established plan of care, and not meeting incident to.