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Thread: Incident to

  1. #1

    Default Incident to

    AAPC: Back to School
    I know Medicare requires Incident to but what about other payors? We have docs that go to satellite clinics everyday. For example:

    Mary normally sees Dr. A in Little Rock, but Dr. B is going to his satellite clinic in Sherwood-well Mary lives in Sherwood so she's going to go ahead and get her chemotherapy there (that has of course been ordered and ok'd by her normal doc). For Medicare we have to do Incident to whatever doc is there at the clinic, so it wouldn't be billed to her normal doc, it would be the one that is at the Sherwood clinic. But what if it's not Medicare....BCBS, Cigna, Qual, etc.???

    I can't find any guidelines other than for Medicare.

    Amanda, CPC
    Anesthesia coder

  2. #2
    Join Date
    Apr 2007
    Milwaukee WI

    Default Huh?

    Incident to is used ONLY for E/M services provided by allied health professional (NP or PA), for an existing patient, with an existing treatment plan.

    If another physician is seeing the patient, you bill under the name of the physician who is seeing the patient.

    If what you are providing is TREATMENT (i.e. chemotherapy), I do not believe you can code an E/M as well.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  3. #3


    You can bill an office visit with chemo using a modifier 25.
    Our thing is when the patient is getting chemo at one of our satellite clinics, they will be under a different doc's supervision. So if Dr. Smith usually sees his patient in Little Rock but today it was more convient for his patient to get chemo in Sherwood where another doctor in the practice is at for the day, Incident to should be that Sherwood doc. Medicare requires this, but haven't found if other payors do.

    My supervisor has recently brought up the fact after reviewing things that it doesn't really make since to bill the chemo charges under Dr. Smith (the pt's normal doc) b/c Dr. Smith wasn't even at the place where the pt was getting chemo.

    Amanda, CPC
    Anesthesia coder

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