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Incident To questions

  1. #1
    Default Incident To questions
    Medical Coding Books
    I have 2 different scenarios, would appreciate any help with these. I can't find any documentation to render an answer.

    Scenario number 1:
    Patient is seen by PA and diagnosed. For future visits, then, this is not an “incident to” visit for the PA and should be billed under the PA's NPI. How do you keep track of this?

    Scenario number 2:
    Patient is seen by PA (billing incident to) for a follow up visit for dx of hypothyroid, hyperlipidemia, and muscle aches. While there, PA renders an additional diagnosis of new onset diabetes mellitus. Does this then negate the incident to billing and become a bill to be done by NPI for PA, or can the new diagnosis be considered a part of the incident to. What then will be the future for this patient with the PA, can he bill incident to if the physician then sees the patient and follows through with plan of treatment? How do the future visits get billed if the PA sees the patient?

  2. #2
    Default
    Incident to is hard to keep track of, I really don't have any advice on making that any easier.

    On the bottom of page 79 I think you will find the answer to your second question though.

    http://www.cms.hhs.gov/manuals/Downloads/bp102c15.pdf

    My interpretation for your 2nd scenario is that it would still be incident to based on Medicare guidelines.

    Good luck,

    Laura, CPC

  3. #3
    Default incident to
    So, my understanding then, is that we would be able to bill incident to even with the new diagnosis, as long as the Dr continues to be active in the treatment plan. Is this what you get?

    For the incident to issue for scenario #1, we decided that the PA would put an I and his initials on the top of the encounter form so we could keep track that way, but that just leaves room for error, so I just wanted to see if anyone else had any suggestions?

  4. #4
    Default
    That is my understanding as well.

    Previously, I worked at a facility that employed a similar process where it was up to the NP or PA or mark the ticket accordingly but as you said that leaves ample room for error. It will be interesting to see how others handle it.


    Laura, CPC

  5. #5
    Default incident to
    Thanks Laura, I appreciate your response. I too will be interested in any other responses. Hopefully we're not the only ones with this issue?

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