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Incident to

  1. #1
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    Greeley, Colorado
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    Red face Incident to
    Medical Coding Books
    I am straining my brain and the more I read the less I know. Question: NPP in multi-specialty group practice performs PFT's prior to the patient seeing the pulmonologist (as a new patient). The NPP's supervising physicians include the PCP who referred the patient (established to him) to the pulomonologist, the ENT specialist, and the pulmonologist. Can the PFT's be billed incident to?
    Lisa Bledsoe, CPC, CPMA

  2. #2
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    Pardon my ignorance, but what is a "PFT"?

    Whatever it is, the NPP can't bill incident-to the pulmonologist because the pulmonolgist has not seen the patient yet. The NPP may be able to bill incident-to the PCP, as long as the "PFT" is part of the treatment plan established by the PCP. Does that make any sense?

  3. #3
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    PFT = pulmonary function test.
    The patient was referred to the pulmonologist who requests PFT's prior to seeeing the patient as it is part of his "diagnostic process". He is the one who signs off on the PFT, so I'm pretty sure it can't be incident to...I just can't stop going in circles. I read something from CMS about certain diagnostic tests could be billed incident to, but I can't find a list of these anywhere. The CMS website is so easy to find stuff on, ya know?
    Lisa Bledsoe, CPC, CPMA

  4. #4
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    Yeah, I know! LOL

    There may be such a list, but you would still have to follow all the other "incident-to" rules, and I don't believe this situation qualifies since the pulmonoligist has not yet seen the patient. You can get around this by having the PCP order the PFT and billing the NPP "incident-to" him/her.
    Walker Bachman, CPC, CPPM

  5. #5
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    Could...except the pulmonologist signs off on it, so how does that affect the situation? He's the one who "wants" it before he sees the patient.
    Lisa Bledsoe, CPC, CPMA

  6. #6
    Location
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    To be incident to Walker22 is correct, the PCP must be the physician that orders the test and has included it as a part of his plan of care, so if the Pulmonologist is the one that wants it and signs off on it then this cannot be incident to the PCP and since the Pulmonologist has never seen the patient then it cannot be incident him either so it must be bill under the NPP number.

    Debra A. Mitchell, MSPH, CPC-H

  7. #7
    Location
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    Thumbs up
    Thanks Debra. I was pretty sure that was correct, but the more I thought about it the more I confused myself...I was realy over-thinking the situation!
    Happy Holidays!
    Lisa Bledsoe, CPC, CPMA

  8. #8
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    Lisa or Deb,

    did either of you ever find a list of some of the more frequently used incident-to codes anywhere?

  9. #9
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    I have not found a list. I searched until my eyes crossed!
    Lisa Bledsoe, CPC, CPMA

  10. #10
    Location
    Columbia, MO
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    There is no list that I am aware of. But then again practically anything could be an incident to service.

    Debra A. Mitchell, MSPH, CPC-H

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