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Thread: incident to billing

  1. #1

    Default incident to billing

    AAPC: Back to School
    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
    Join Date
    Apr 2007
    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
    Join Date
    Apr 2007
    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

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