Gastroenterology Coding Alert

Question: I-m confused about physician supervision rules. Specifically, if Dr. Smith devises the plan of care, but Dr. Jones--another GI in our group practice--covers for Dr. Smith while he is on vacation, can we still bill for NPP services for Dr. Smith's patients while he is away?


Arizona Subscriber

Answer: Your confusion is warranted, and a simple answer to your question is difficult to come by.

In September 2004, CMS released -Transmittal 20,- which stated that the supervising physician and the ordering physician don't have to be the same person for incident-to services. CMS instructed coders to put the ordering physician's name in Box 17 and the supervising physician's signature in Box 31 on the CMS-1500 form.

Under these rules, Dr. Jones can act as the supervising physician for incident-to services your nonphysician practitioners (NPPs) provide, even if Dr. Smith devised the plans of care. Many physicians and coders- advocates felt that this was an excellent change from earlier practice.

A big -but --: CMS later sent out a notice that it was withdrawing Transmittal 20. The agency issued Transmittal 20 -in error,- it said, and offered no target date to issue a new policy. You-ll no longer be able to find the transmittal on the CMS Web site--and the agency has also rescinded its earlier incident-to transmittal, Transmittal 17.

CMS- announcement doesn't seem to have reached most providers, who remain unaware that the agency withdrew its incident-to guidance. And CMS was not clear regarding what it expects providers to do now when two different physicians are involved in incident-to billing.

In the absence of an explicit policy from CMS, you should always assume that the ordering and supervising physician for an incident-to service must be the same person. Therefore, you should not report services incident-to Dr. Jones if Dr. Smith devised the plan of care.

Warning: You should never claim that a doctor was supervising incident-to services when she was actually on vacation or otherwise out of the office, for instance.

Documentation tip: Ask the practitioner to write on the top of the charge sheet the initials of the physician who was present during the service, some coding experts recommend.