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Another Incident to question, "Oh by, the way"

  1. #1
    Everett, WA
    Default Another Incident to question, "Oh by, the way"
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    Client comes in to see the NP for ongoing treatment that captures all the necessary elements to bill for "incident to" scenario. BUT during the course of the visit patient says, "And oh, by the way, I have this new problem that I need you to check on...."

    How can this be avoided and at the very least, how should we change gears at this point? It no longer can be billed incident to, correct? I've been reading the MCR Guidelines and trying to retrieve all the message from the past on this forum relating to the subject. Is there any additional authoritative documentation we can use when explaining to the doctor that we can not bill this visit as incident to?

    Suzanne E. Byrum, CPC

  2. #2
    Evansville Indiana
    Default incident to
    I personally spoke with an NGS clinical consultant just recently for guidance on this and was told that if anything happens during a visit that "violates" the guidelines it must be bill under the NP's NPI. The physician cannot come in and see the patient in order to bill under his/her number, you also cannot bill the visit based upon the original complaint only. I guess that you could tell the patient "You will have to come back for that problem" but that wouldn't be good PR and the patient would probably blow a gasket. I know I would.

    She stated that only strictly follow up visits with no change in treatment plan can be considered "incident to"
    How often does that happen??? Maybe a follow up of a simple ear infection or follow up of a simple injury. To me personally, billing incident to is not worth the hassle and risk and does not utilize the time and talents of the NP.


  3. #3
    North Carolina
    I would bill under the NPP's NPI to ensure that compliance measures are maintained...

    As explained in ยง60.1, this does not mean that each occasion of an incidental service performed by a nonphysician practitioner must always be the occasion of a service actually rendered by the physician. It does mean that there must have been a direct, personal, professional service furnished by the physician to initiate the course of treatment of which the service being performed by the nonphysician practitioner is an incidental part, and there must be subsequent services by the physician of a frequency that reflects the physician's continuing active participation in and management of the course of treatment. In addition, the physician must be physically present in the same office suite and be immediately available to render assistance if that becomes necessary.

    Section 60
    Rebecca CPC, CPMA, CEMC

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