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Thread: Need help with incidental to billing.

  1. #1
    Join Date
    Apr 2007
    Lehigh Valley

    Default Need help with incidental to billing.

    AAPC: Back to School
    Hello all,

    We have a PA-C who sees patients on a daily basis. We perform bariatric surgeries in addition to general surgery.

    My question is this, as far as incidental billing goes...if the PA sees a patient of another doc in the practice, is it still considered incidental or should I be billing out under her numbers???

    One of our physicians does not do the bariatric surgery. It is with this doctor that I am having doubts as to whether or not it really can be considered incidental to. He is in the office, himself, doing office hours along side of her, but occasionally she has been seeing the bariatric patients. If she has a question about one of the patients and the other doctor cannot help her (one in the office), she does speak with the physician (who cares for the patient) by telephone and does document this in her notes.

    Is this incidental to or should I be billing this out under her number?????

    Thanks for the help!

  2. #2
    Join Date
    Apr 2007


    Incident to rules apply to Medicare, your commercial carriers will all have their own rules. The instances where the physician is available only by telephone are not incident to. The physician must be in the immediate office suite in order to bill incident to. Also make sure they are established patients with established problems. Hope this helps.

  3. #3
    Join Date
    Apr 2007
    Toms River, NJ


    You may bill incident to if the physician in the office is of the same specialty as the physician that originally saw the patient. if this visit is to follow the plan that the physician already laid out then you can bill incident to. if the patient is being seen for something else or a new complication or complaint then you must bill under the PA's id number.

  4. #4
    Join Date
    Apr 2007
    Lehigh Valley


    Thank you for responding. I very much appreciate it!


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