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Incident to New Problem

  1. #1
    Question Incident to New Problem
    Medical Coding Books
    I am presently dealing with a situation where the physician allows the CRNP to see a patient incident to for new problems. Example: a patient was in two weeks ago for her annual exam and comes back in for a c/o of itiching/possible yeast infection. The yeast infection is a new problem, can the CRNP see the patient and treat w/o physician care plan? Can this be billed incident to or does the doctor have to see the patient?

  2. #2

    I recall that when billing services as "incident to", "new" conditions had to first be seen/treated by the MD. I found the following info on Medicare's website regarding services eligible for "incident to" billing;

    The service(s) must represent an expense to the physician or non-physician practitioner (NPP). The service(s) must be one(s) that is commonly furnished in physicians or NPP's offices or clinics. The service(s) must be commonly rendered without charge or included in the physicians or NPP's bill. The service must be rendered under the direct supervision of the physician or NPP and the physician or NPP must evaluate and initiate the plan of care (see CMS Internet Only Manual (IOM), Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 60.1).

    I think that the wording "initiate" indicates that the MD must begin course of treatment for "new" conditions.

    Hope this helps!
    Sylvia Thompson, CPC
    Billing Supervisor
    San Diego, CA

  3. #3
    That is what I thought but just wanted verification...the doc is thinking that something as minor as a yeast infection should not need his attention...


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