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Anesthesia Coding Alert

Reader Question:

Untangle Incident-to and TP Indicators

Published on Thu Mar 01, 2007

Question: How should I code incident-to services when our pain management specialist is in the office? What modifier should I use when he is not in the office and the nurse practitioner (NP) sees a patient by herself?

Colorado Subscriber

Answer: Provider identification numbers (PINs), not modifiers, tell payers about an encounter's performer/supervisor. To indicate that the service meets Medicare's incident-to criteria, you should report the service using the physician's PIN. The claim is blind as to whether an NP or physician performed the service, so payers reimburse the claim at 100 percent.

Remember: Incident-to implies the nurse practitioner provided the services under a physician's "direct supervision" following an established plan of care.

When an NP performs a service without the physician's direct supervision, following an established treatment plan or evaluating a new problem or complaint, you instead should report the code under the NP's PIN. You should use the same procedure codes as with incident-to.

Caution: Before allowing your nurse practitioner to provide services without direct supervision, make sure your state's scope-of-practice and licensure laws permit doing so.


Teaching distinction: You might be confusing teaching facility supervision with physician supervision. In a teaching facility, you indicate the teaching physician's involvement with these modifiers:

• GC -- This service has been performed in part by a resident under the direction of a teaching physician
• GE --This service has been performed by a resident without the presence of a teaching physician under the primary-care exception
• GR -- This service was performed in whole or in part by a resident in a Department of Veterans Affairs medical center or clinic, supervised in accordance with VA policy.


Answers to You Be the Coder and Reader Questions were reviewed by Tonia Raley, CPC, claims processing manager for Medical Information Systems in Phoenix.

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