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Thread: Incident to or Direct Bill situation

  1. #1

    Default Incident to or Direct Bill situation

    AAPC: Back to School
    Established patient has been followed in the office for A-Fib. Patient now presents for Chest Pain. Nurse Practitioner sees alone (with no MD). Would this be Direct Bill??

  2. #2
    Join Date
    Apr 2007


    Chest pain would be a new problem, I'm guessing, so it would not qualify for incident to. This should be billed under the NP.

    Laura, CPC, CEMC

  3. #3
    Join Date
    Apr 2007
    Atlanta Perimeter Professional Coders


    Is there a plan of care in the physician's note? Is the NP working it up as a new problem? My inclination is to direct bill.

  4. #4


    There is no physician note in reference to the Chest Pain visit, just the NP's note.
    I was stumped on this one because Chest Pain is a symptom of A-Fib. So.. if the patient is already being followed for A-Fib, then the Chest Pain could be related to that previous condition of A-Fib and they should be able to bill 'incident to'.
    On the other hand, chest pain is related to several things.....

  5. #5
    Join Date
    Apr 2007


    Chest pain could be related to any number of things, if the patient is coming in for an acute episode, I would not consider it incident to.

    Laura, CPC, CEMC

  6. #6


    That's exactly what drew me away from 'incident to', but I needed to 'talk it out'...

    Thank You.

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