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incident-to services

  1. Default incident-to services
    Medical Coding Books
    Patient was seen by Dr. Name on 1/21/10 and a plan of care was established for back and neck pain.

    Patient returned on 2.15.10, for follow-up of back and neck pain and was seen by NPP.
    NPP discontinued medication started by Dr. Name for back and neck pain.
    NPP added new medication (Gabapentin and Tramadol) for back and neck pain.

    Could this still be billed as incident-to since the NPP changed the plan of care?

    No new problems were presented by the patient or addressed by the NPP.

    NPP discussed med changes with Dr.

    Please give reason for or against incident-to. Thanks.
    Last edited by clowe; 05-12-2010 at 06:12 AM. Reason: add more information

  2. #2
    Location
    Columbia, MO
    Posts
    12,837
    Default
    I say no this is not incident to and should be billed under the NPP's NPI

    Debra A. Mitchell, MSPH, CPC-H

  3. Default
    Please share your reasoning to help me understand. Thanks.

  4. #4
    Location
    Milwaukee WI
    Posts
    4,466
    Default Treatment plan
    The NPP was changing the treatment plan, not simply following the patient for a treatment plan put in place by the physician. THAT is why the visit must be billed uder the NPP's name/number.

    In order to be "incident to"
    1) established patient
    2) established problem
    3) existing treatment plan

    If any of the above is not met, the visit cannot be coded as incident to. (Medicare thinks "consultations" were abused?! THIS will be the next area CMS eliminates ...)

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

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