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Help -- incident-to E/M billing

  1. Question Help -- incident-to E/M billing
    Medical Coding Books
    I am having a disagreement with my MDs on the incident-to billing of E/Ms. I know that we can NOT bill incident-to for and E/M if the MD is not in the "suite". My belief is that we have to bill the E/M incident-to the MD that is in the "suite"...for example Dr. Jones is the primary MD...the patient come in on a day when Dr. Jones is on vacation...the patient sees the NP for an E/M...Dr. Smith is in the office "suite". I'm lead to believe that we can bill that incident-to under DR. Smith (since she is in the 'suite") and to bill the E/M under Dr. Jones would be wrong since she is not there. My MDs believe that since another MD is in the "suite" (Dr. Smith) that it is OK to bill the E/M incident-to under Dr. Jones whom is NOT in the "suite".

    I can not seem to find clarification on this on any insurance web sites.

    (I know that labs, injections and x-rays do not fall under the incident-to only concern it E/M incident-to.)

  2. #2
    Yes, the physician MUST provide 'direct supervision' and CMS defines 'direct supervision' in that the physician MUST be present in the office suite to render assistance, if necessary. This is clearly stated on CMS' website. I copied the link for that page to this response. Hope this helps...
    Last edited by kandigrl79; 08-27-2007 at 11:52 AM.

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