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Thread: More "incident to" questions

  1. #1
    Join Date
    Apr 2007
    Everett, WA

    Default More "incident to" questions

    AAPC: Back to School
    At the advice of another sage veteran, am posting my question to you who are experienced in billing in regards to PA's. I've done the homework, checked out nat'l MCR and Noridian carrier guidelines and dwelled amongst the "scope of practice statues" from Washington State. I've cut and pasted, researched to the bones, and need to finalize a few things:
    When performing a physical and the PA comes across a new problem (which more than likely will happen, right), this will negate "incident to" billing as it doesn't follow the 3 "E's. Is this one of those "it depends" scenarios? I'm just not sure as to how I should structure an explanation to her. Basically the doctor's question is:

    "... I’m dense and still wrapping my head around new PA guidelines.
    1) If a PA does a physical is it billed incident to or is that like a “new problem” type of visit?

    I' "dense" too, because I'd like to have a reasonable explanation to this question and am tempted to align with the conservative side of saying this must be billed beneath the PA's number, since most likely new problems will be found. What do you think?

    ---Suzanne E. Byrum, CPC

  2. #2
    Join Date
    Apr 2007
    Columbia, MO


    I have always gone by the logic that an annual exam cannot be billed incident to. Because the physician has not examed the patient prior to this visit and ordered this encounter "as a followup visit".
    Also if a new problem is encountered or a flair up of an old problem then it does negate incident to.

    Debra A. Mitchell, MSPH, CPC-H

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