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Incident to or Direct Bill situation

  1. Default Incident to or Direct Bill situation
    Medical Coding Books
    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. Default
    I say it should be Direct Bill because Medicare guidelines state that the physician has to initially treat the patient for that condition in order for it to considered 'Incident to', but does anyone else have a different point of view??

  3. #3
    Default direct bill
    I agree, direct bill. Not an incident to situation unless documented previously.

  4. Default
    Yah, I was going back and forth. The guidelines state 'new condition'. Chest Pain was never mentioned before so it's a new condition therefore it would be Direct Bill since the physician did not initially see the patient for it.
    On the other hand, Chest Pain is a symptom of A-Fib. So if the chest pain was related to the previous diagnosis of A-Fib (of which the physician did initially see the patient for), then I kind of felt that they might be able to bill it as 'incident to'.
    But on the other hand, chest pain is a symptom of a lot of things.

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