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Incident To?

  1. #1
    Location
    New York State Capital District Professional Coders, Albany, NY
    Posts
    12
    Default Incident To?
    Exam Training Packages
    Can a preoperative clearance be an incident to scenario? Patient is seen by Primary Care for abdominal pain. PCP does testing and determines patient has pancreatic cancer.So the pancreatic cancer dx is established by the PCP. PCP refers patient off to Oncology, but that's all the PCP documents; no other plan of care. Two months later the Oncologist refers the patient back to PCP for preoperative clearance for surgery to remove the pancreas. The NP sees this patient because the PCP's schedule is filled. The PCP is in the office on the day the patient sees the NP for this clearance. Is this a preoperative clearance scenario because the PCP established the patient has the pancreatic cancer? Your thoughts and insight to this would be most welcomed. What would be the best resource to refer back to? I know all about CMS website - this specific scenario is not discussed. Thank you so much.

  2. #2
    Location
    Milwaukee WI
    Posts
    4,466
    Default NOT incident to
    This is NOT incident to. Bill the documented E/M service under the NP's name/NPI.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  3. #3
    Location
    New York State Capital District Professional Coders, Albany, NY
    Posts
    12
    Default
    I appreciate your response. I agree with you.

    How can this be rationalized with the CMS guidelines so that providers understand? CMS says in essence a problem has to be established by the MD with a plan of care set up before the NP can see the patient and bill incident to. So I'm hearing that providers feel the establishment of the pancreatic cancer allows the NP to bill incident to for the preoperative clearance because the PCP established this problem in the first place. Any input or thoughts from the great Coder's out there would be greatly appreciated. Thank you.

  4. #4
    Location
    Milwaukee WI
    Posts
    4,466
    Default Okay, try this
    So if the PCP is claiming that this was HIS plan of treatment that the NP is following (i.e. "incident to") ... That means that he previously made a decision for surgery, and therefore the visit to complete admission paperwork is NOT billable at all, because it is global to the surgery.

    On the other hand, if the surgical plan is NOT his treatment plan, the NP can bill under her own name/NPI number.

    Can't have it both ways.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

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