Page 1 of 2 12 LastLast
Results 1 to 10 of 12

Incident to

  1. #1
    Exclamation Incident to
    Medical Coding Books
    Could someone help with a debate in my office. I've tried to explain that a Physican must be in our office suite while a NP is seeing patients in order to allow us to bill services correctly. However, I continue to hear that state law doesnt require a physican in the office but as long as he/she is accessible to the NP.
    Could someone assist me with this debate as I know CMS or Federal quidelines override state requirements?

  2. Question Incident To
    My question is also regarding Incident To.
    Dr sees pt today, pt comes back in a few days
    for a penicillion injection ordered at the 1st visit.
    RN administers injection, DR is "readily available".
    RN wants to bill 99211, 90772 and J0580.
    Can she bill all 3? Her documentation really only
    supports the injection, but according to CMS
    99211 and 90772 can't be billed together?

    Rose
    Last edited by machi57; 10-15-2008 at 07:37 PM. Reason: type error

  3. Default
    Quote Originally Posted by pattis9 View Post
    Could someone help with a debate in my office. I've tried to explain that a Physican must be in our office suite while a NP is seeing patients in order to allow us to bill services correctly. However, I continue to hear that state law doesnt require a physican in the office but as long as he/she is accessible to the NP.
    Could someone assist me with this debate as I know CMS or Federal quidelines override state requirements?
    You are correct about Medicares guidelines. For incident to rules the physician does have to be in the suite with the NP/PA. In addition a physician needs to have seen the patient initially for that diagnosis. If the NP/PA diagnosed the patient initially then the visit cannot be considered incident to.

    You can find this in detail on the CMS website. Below i have copied the passage pertaining to this. Here is the website http://www.cms.hhs.gov/MLNMattersArt...ads/SE0441.pdf


    To qualify as “incident to,” services must be part of your patient’s normal course of treatment, during which
    a physician personally performed an initial service and remains actively involved in the course of
    treatment. You do not have to be physically present in the patient’s treatment room while these services
    are provided, but you must provide direct supervision, that is, you must be present in the office suite to
    render assistance, if necessary.
    Last edited by s9uccess; 10-15-2008 at 11:50 PM. Reason: additional information

  4. Default
    Quote Originally Posted by pattis9 View Post
    Could someone help with a debate in my office. I've tried to explain that a Physican must be in our office suite while a NP is seeing patients in order to allow us to bill services correctly. However, I continue to hear that state law doesnt require a physican in the office but as long as he/she is accessible to the NP.
    Could someone assist me with this debate as I know CMS or Federal quidelines override state requirements?
    Forgot to mention that for commercial insurances this can vary. I have found that they don't necessarily follow incident to rules. For example we have been told that although Regence follows Medicare guidelines they want NP/PA billed in their own.

  5. #5
    Default
    Quote Originally Posted by machi57 View Post
    My question is also regarding Incident To.
    Dr sees pt today, pt comes back in a few days
    for a penicillion injection ordered at the 1st visit.
    RN administers injection, DR is "readily available".
    RN wants to bill 99211, 90772 and J0580.
    Can she bill all 3? Her documentation really only
    supports the injection, but according to CMS
    99211 and 90772 can't be billed together?

    Rose
    Rose, if the patient came back for an injection ONLY, then that is what should be billed (90772 & J0580). What was the medical necessity for the 99211?
    Evangelina Frohna, CPC, CEMC

  6. #6
    Location
    Milwaukee WI
    Posts
    4,466
    Default Forget Incident To
    Forget "Incident to" for a minute ... why aren't the NP's services coded separately?

    In some of our specialties the NP has his/her own clinic and handles everything, including new patients. We code and bill under the NP's name.


    F Tessa Bartels, CPC, CPC-E/M

  7. #7
    Default
    The reimbursement rate is higher when they are billed incident to. For Medicare they reimburse at 100% of the physician fee schedule when billed incident to but only 85% when billed non incident to.


    Laura, CPC

  8. #8
    Location
    Milwaukee WI
    Posts
    4,466
    Default Please tell me ...
    Quote Originally Posted by katmryn78 View Post
    The reimbursement rate is higher when they are billed incident to. For Medicare they reimburse at 100% of the physician fee schedule when billed incident to but only 85% when billed non incident to.


    Laura, CPC
    Please tell me you are NOT coding based on how you'll be reimbursed vs coding based on the service provided!

    F Tessa Bartels, CPC, CPC-E/M

  9. #9
    Default
    Nothing is 'coded' differently with incident to - it's a physician's or practice's decision if they wish to utilize "incident to" or have the NP's seperately enroll. Not a coders decision.

    From my personal experience, incident to is just a big pain and trying to get everyone on the same page with documentation and following the guidelines is pretty difficult. Our NP's and PA's are seperately enrolled, so yes they take the 15% cut, but in most cases, it's worth it.

    I recently did an audit at a practice that "thought" they were billing incident to correctly - long story short, they had to refund Medicare over $100K.

  10. #10
    Default Response to FTessaBartels
    Please read what was said before you question my ethics in the future. I would greatly appreciate that. I responded to why people would bill NP's incident to. That was not a coding question, that is a billing question.

    Laura, CPC

Page 1 of 2 12 LastLast

Similar Threads

  1. Incident to
    By brownie in forum Cardiology
    Replies: 2
    Last Post: 09-05-2013, 11:39 AM
  2. incident to - If a physician is in the office
    By tbrannan in forum Urology
    Replies: 2
    Last Post: 03-27-2012, 10:30 AM
  3. incident to
    By tbrannan in forum Urology
    Replies: 0
    Last Post: 03-01-2012, 02:22 PM
  4. Incident to:
    By shadith4 in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 11-24-2010, 11:39 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?

Login

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.