Defining new problem in "incident to" billing

Hello
I have an incident to question. The patient has an established care plan initiated by the MD and is scheduled to see the NP for follow-up. If there are no new problems addressed we would bill incident to under the MD's provider number. What happens if in addition to the chronic medical conditions addressed by the NP, the patient has a new "insignificant" problem? If the patient comes in with a significant new problem the NP calls the MD into the room and he sees the patient. However, if the new problem is minor, URI, benign skin lesion, stubbed toe, etc., the NP addresses alone. Since the chronic, already diagnosed conditions are also treated can we bill this service as incident to? The MDs are balking because some of these "by the way" new problems are so minor.
Thanks

Beth

Beth Aldridge, CPC
Coding Manager

Northern California Medical Associates, Inc
Phone: (707) 573-6145
Fax: (707) 573-6932

Comments

  • edited May 2017
    Hi,

    I asked this question several years ago and received an answer back from NHIC medical director stating that if ANY new problems are addressed, it cannot be billed incident-to. I no longer have that e-mail as it was at a different company and NHIC part B doesn’t exist anymore anyway.

    I would recommend writing to your MAC and getting it in writing from them what their position is on this.

    Good luck!

  • Thanks, that is a good idea

    Beth Aldridge, CPC

    Coding Manager



    Northern California Medical Associates, Inc

    Phone: (707) 573-6145

    Fax: (707) 573-6932



  • edited May 2017
    Just bill under the NPP ID as not incident to its a slight fee schedule adjustment but I'm sure it's better than bothering MD or rescheduling patient.
    We liked a personal touch so we always called to confirm appointments and told the patient what they were scheduled for and asked if there was anything else . If something more was needed we would at times schedule w MD

    Marie Popkin, CPC
    Coding,Consulting & Compliance



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