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Incident-To Billing/Medical Records question

  1. #1
    Default Incident-To Billing/Medical Records question
    Medical Coding Books
    I would like the opinion of other CPC's, please. If we bill incident-to for a PA with the physician in the office at that time but the medical record is signed by another physician with the PA, is that compliant? Would it pass an audit?

    Thank you for any help you can offer.

  2. #2
    I do not believe that would pass audit.
    Walker Bachman, CPC, CPPM

  3. #3
    Is that a requirement in your state, to have the physician sign the note too?

    It is not here in Michigan or for CMS. There is more to incident to than the physician being in the office at the time of the service. But to that point CMS sees all providers of the same specialty in the same group as the same person so it wouldn't matter if it was Dr. As pt but Dr. B was the one physically in the office when the PA did the service.

    I understand you are saying that the correct doctor was in the office at the time of service, so why would another doctor sign off on the note that wasn't there anyway?

    Laura, CPC, CPMA, CEMC

  4. #4
    We went through a Medicare audit and got in some trouble because the doctor we used as the billing provider was not the one that signed off on the chart. (both doctors were in the office suite at the same time).
    Walker Bachman, CPC, CPPM

  5. #5
    Default Reply to katmryn78
    The surgeon who normally treats the patient is NOT in the office. Another physician with the practice is present. However, there are times when the medical record is electronically signed by the surgeon who was NOT in the office and was not the doctor indicated on the charge slip. As such, the charge slip and the medical record are in conflict.

    Thanks for your advice, everyone.

  6. #6
    Again, why are they signing the note at all?

    I'm sorry if I misunderstand your original post but I still read it that the correct provider was there but a different one signed off.

    Unless the doctor in the office is of a different specialty/group it shouldn't matter that they were not the original provider the PA was working under. For billing though you should be using the one that is actually in the office on the date of service. Since billing under a provider that is not there does not meet incident to requirements.

    Laura, CPC, CPMA, CEMC

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