# Incident to or Direct Bill situation



## cvand1972 (Aug 11, 2009)

Established patient has been followed in the office for A-Fib.  Patient now presents for Chest Pain.  Nurse Practitioner sees alone (with no MD).  Would this be Direct Bill??


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## LLovett (Aug 11, 2009)

Chest pain would be a new problem, I'm guessing, so it would not qualify for incident to. This should be billed under the NP.

Laura, CPC, CEMC


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## VRock (Aug 11, 2009)

Is there a plan of care in the physician's note?  Is the NP working it up as a new problem?  My inclination is to direct bill.


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## cvand1972 (Aug 11, 2009)

There is no physician note in reference to the Chest Pain visit, just the NP's note.
I was stumped on this one because Chest Pain is a symptom of A-Fib.  So.. if the patient is already being followed for A-Fib, then the Chest Pain could be related to that previous condition of A-Fib and they should be able to bill 'incident to'.  
On the other hand, chest pain is related to several things.....


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## LLovett (Aug 11, 2009)

Chest pain could be related to any number of things, if the patient is coming in for an acute episode, I would not consider it incident to.

Laura, CPC, CEMC


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## cvand1972 (Aug 11, 2009)

That's exactly what drew me away from 'incident to', but I needed to 'talk it out'...

Thank You.


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