Results 1 to 4 of 4

Incident to questions

  1. #1
    Default Incident to questions
    Medical Coding Books
    My provider just asked me a couple questions that I could not answer.

    NP seeing patient incident to a physicians plan of care. Is there a requirement that the physician needs to see the patient after a certain period of time and if so, how often?

    Dr. A has established a plan of care, but is out of the office for the day. NP is seeing Dr. A's established patient in followup to his plan of care. Dr. B is supervising the NP on this date. Can this visit be billed as incident to under Dr. B since they are in the same group practice?
    penny0222

  2. #2
    Location
    North Carolina
    Posts
    3,126
    Default
    Quote Originally Posted by PennyG View Post
    My provider just asked me a couple questions that I could not answer.

    NP seeing patient incident to a physicians plan of care. Is there a requirement that the physician needs to see the patient after a certain period of time and if so, how often?

    Dr. A has established a plan of care, but is out of the office for the day. NP is seeing Dr. A's established patient in followup to his plan of care. Dr. B is supervising the NP on this date. Can this visit be billed as incident to under Dr. B since they are in the same group practice?
    1st question: My carrier has a policy that the physician should see the patient at a frequency of every 3rd visit.

    2nd question: As long as your following physician's A plan of care, you can bill incident to with physician B in the office. I have asked this very question in a Medicare conference and was assured it is allowed as long as you don't deviate from physician's A plan of care.

    Link below pertains to question #1-

    http://www.cignagovernmentservices.c...0103id01c.html

  3. #3
    Default incident to questions
    Rebecca,

    thank you for the response to my incident to questions. I just wish to clarify the Dr. A-Dr. B question. We would submit the claim with Dr. B's info, since he is the one in the office supervising, correct? Even though the plan of care being followed is Dr. A's.
    penny0222

  4. #4
    Location
    North Carolina
    Posts
    3,126
    Default
    That is correct. Although Physician A established the treatment plan, you would report the services under Provider B since he is supervising on-site.

    In highly organized clinics, particularly those that are departmentalized, direct physician supervision may be the responsibility of several physicians as opposed to an individual attending physician. In this situation, medical management of all services provided in the clinic is assured. The physician ordering a particular service need not be the physician who is supervising the service. Therefore, services performed by auxiliary personnel and other aides are covered even though they are performed in another department of the clinic.

    Supplies provided by the clinic during the course of treatment are also covered. When the auxiliary personnel perform services outside the clinic premises, the services are covered only if performed under the direct supervision of a clinic physician. If the clinic
    refers a patient for auxiliary services performed by personnel who are not supervised by clinic physicians, such services are not incident to a physician’s service.


    Page 82

    https://www.cms.gov/manuals/Downloads/bp102c15.pdf

Similar Threads

  1. CPC practice exam questions vs. CPC actual exam questions
    By kbearden1985 in forum Medical Coding General Discussion
    Replies: 12
    Last Post: 02-02-2017, 12:43 PM
  2. incident to questions
    By grace hagen in forum Medical Coding General Discussion
    Replies: 1
    Last Post: 02-01-2013, 09:30 AM
  3. Incident to questions
    By rnewsome in forum E/M
    Replies: 3
    Last Post: 08-10-2011, 05:46 PM
  4. More "incident to" questions
    By ollielooya in forum Medicare Regulations
    Replies: 1
    Last Post: 12-06-2010, 11:42 AM
  5. Incident To questions
    By Anna Weaver in forum E/M
    Replies: 4
    Last Post: 12-12-2008, 01:07 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.