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Incident to question

  1. #1
    Default Incident to question
    Medical Coding Books
    If the PA sees the new patient and bills under their NPI like should be done and the patient follows up with the MD on the second visit can the visits after that be billed as incident to even though the PA was the first to see the patient?
    Herbie W Lorona Jr., CPC, CPC-H
    hlorona@up2parmedicalclinic.com

  2. #2
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    If the PA billed an E/M and not a procedure, then there's no global period, so there's nothing to be considered "incident to". Even if he did bill an actual procedure, the global period doesn't apply to the MD, because you billed the PA's individual NPI as the rendering provider, and the MD will have a different individual NPI.

    However, the MD's visit will be considered Established and not new, because he is the PA's supervising physician, so they will be considered part of the same practice and same specialty. Hope that helps!

  3. #3
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    Quote Originally Posted by Herbie Loroña View Post
    If the PA sees the new patient and bills under their NPI like should be done and the patient follows up with the MD on the second visit can the visits after that be billed as incident to even though the PA was the first to see the patient?
    The visits after the MD encounter MIGHT be billable as incident to but only if the PA is providing followup on the MD encounter and the MD has a plan of care documented in his encounter to show that the patient is instructed to come for follow up. Just because the patient saw the MD does not automatically make the next visit with a PA or NP incident to.

    Debra A. Mitchell, MSPH, CPC-H

  4. #4
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    Quote Originally Posted by mitchellde View Post
    The visits after the MD encounter MIGHT be billable as incident to but only if the PA is providing followup on the MD encounter and the MD has a plan of care documented in his encounter to show that the patient is instructed to come for follow up. Just because the patient saw the MD does not automatically make the next visit with a PA or NP incident to.
    Thank you Debra,

    That is what I was referring to was if he saw the patient afterwards and documented the plan of care and to follow up on it if that could be considered incident to. Just didn't explain it in detail. Yeah I understand that it doesn't automatically make next visit incident to. Thank you for your input. Much appreciated
    Herbie W Lorona Jr., CPC, CPC-H
    hlorona@up2parmedicalclinic.com

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