Results 1 to 3 of 3

incident to billing

  1. Default incident to billing
    Medical Coding Books
    When services are billed incident to a physician, by a nurse practitioner and/or physician assistant, what type of documentation do they need within the medical record to show direct supervision?

    Thank you

  2. #2
    Concord, NC or Rochester, NY
    Incident to is simple, it is a MD extender that performs the service and bills under the MD as this pays at 100% instead of 85%.

    The Medicare rules to this are:
    1. It must be within the scope of practice of the physician extender (PA, NP)
    2. There must be a treatment plan in place. The MD has to be involved in the patient care so if it is an ongoing/chronic problem, they should be seeing the patient periodically.
    3. It must be an employee of the practice
    4. MD must be in the suite - I have seen where a doctor stepped out for a cigarette and medicare documented this so hence they were not within the suite and hence no incident to. The MD must be in the suite, not at lunch, not in another office, not visiting another MD in the same building, etc.

    These are the basics but there could be differences with different insurance carriers.

    No documentation is necessary in the chart per se. The insurance carrier will be able to see if the MD was in the suite via the scheduler and/or MD calendar.

    I think it is always best for the MD to sign and date the chart to have some type of proof but this is not really necessary

  3. #3
    Greater Atlanta
    Default State regulations for Nurse Practitioners
    We are trying to find something in writing for our state, Georgia, to know if a nurse practitioner is allowed to see new patients in our outpatient clinic? We know it varies state to state, but can't seem to find it.
    Can anybody help direct us?
    Thanks in advance.
    Inpt & Outpt Coder

Similar Threads

  1. Replies: 3
    Last Post: 10-26-2016, 11:10 AM
  2. Incident to billing
    By kellyal in forum Family Practice
    Replies: 0
    Last Post: 08-29-2013, 12:38 PM
  3. Incident to billing - orthopaedic practice
    By doodiebuggy in forum Medical Coding General Discussion
    Replies: 2
    Last Post: 04-18-2011, 11:22 AM
  4. Replies: 0
    Last Post: 09-23-2009, 11:18 AM

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?


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.