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Thread: Incident to billing

  1. #1

    Default Incident to billing

    AAPC: Back to School
    A cardiologist would like to bill incident to for an APRN that see's his patients in the office when the APRN assesses the patient and makes a change to a plan of care. As a credentialed provider, shouldn't the APRN bill for the services under her own NPI?
    I believe if the provider does not have any face-to-face time with the patient, and is only signing off on the APRN's assessment, that it does not qualify for incident to. Does anyone know where i could find this specific information; the medicare web site does not address the 'assessment' and change of plan of care that i can find.

  2. #2
    Join Date
    Apr 2007
    Columbia, MO


    In the incident to definition it states that there must be a plan of care in the chart that states the patient is to return and what is to be done or discussed. If anything is changed then it is not following the care plan in the chart so it is not incident to. Also in CR 1776 it states that if the physician does not have a face to face encounter with the same patient for the same reason ( even if the provider signs off on the documentation provided) then the visit must be billed using the NPI for the Nurse practictioner

    Debra A. Mitchell, MSPH, CPC-H

  3. #3


    that was our understanding as well,but the physician is insisting we find something in writing. thank you.

  4. #4
    Join Date
    Apr 2007

    Default Documentation

    Trailblazer health has a good paper "documentation requirements for cpt code 99211. So does family practice management has on-line articl called "ins and outs of "Incident-To" reimbursement". Nov-Dec 2001

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