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Incident to/direct billing

  1. #1
    Question Incident to/direct billing
    Medical Coding Books
    Hi, I need help our office has question concerning Incident to /direct billing, I have an example if anyone can give me an answer I would really appreciate it. Patient presents to the office for a visit with a NP/PA ,patient has diabetes ,hypertension., patient now has an ulcer on their toe. Now patient has a new diagnosis of diabetes with ulcer. Is this a new diagnosis or a follow up to diabetes? Does this constitute a new diagnosis? therefor would this be billed as Direct or incident to? How would Medicare guidlines define this?

  2. #2
    Location
    Milwaukee WI
    Posts
    4,466
    Default New problem
    You say ... patient has diabetes ,hypertension., patient now has an ulcer on their toe. Now patient has a new diagnosis of diabetes with ulcer.

    I'd say this is definitely a new problem, so I'd go with direct billing. The physician can't have formulated a plan of treatment for a problem that didn't exist before. (i.e. the ulcer).

    Just my opinion.

    F Tessa Bartels, CPC, CEMC

  3. #3
    Default
    Thank you, Katie
    Katie Mills, CPC
    Billing Leader
    Hanover Family Practice

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