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Incident to questions

  1. Default Incident to questions
    Medical Coding Books
    Need help in understanding when to bill incident to. New patient in office or in hospital setting; if NP sees the patient and does the work up, physician comes in and does face to face briefly and signs note. Nothing documented that physician was there, only has his signature and NP dictates hospital note. Is this to be billed under physician NPI for billing, rendering and supervising provider? Also, if NP sees an established patient and physician does not see the patient, we bill under physician billing NPI, but NP rendering and supervising NPI. Hope this makes sense.

  2. #2
    An NPP's services must meet several criteria in order to qualify as “incident-to” for billing purposes. These include:

    •The NPP must be licensed or certified to provide professional health care services in the state where the physician practice is located.
    •Generally, the NPP must be a full-time, part-time or leased employee of the physician or physician group practice (although in limited cases, the NPP may be an independent contractor of the physician or physician group practice).
    •The NPP must provide services as an integral part of and incident-to the physician's services.
    •The NPP must provide such services under the direct supervision of the physician.

  3. Default
    He does meet the requirements.

  4. #4
    Columbia, MO
    For the new patient encounter, the NP must bill under their own NPI, you cannot share a new patient. Also if you are going to have a shared encounter then the provider must dictate his own note to say he has examined the patient he cannot just sign off on the NPs note.. see CR1776 "if there is no face to face encounter between the provider and the patient documented (even if the provider signs off on the NPPs documentation) then the visit must be billed using the NPPS number.
    For your established patient, you can bill under the physician number as long as the patient meets the incident to definition which is this is a follow up for an established problem and the provider is present in the office suite area.

    Debra A. Mitchell, MSPH, CPC-H

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