General Surgery Coding Alert

Assume that ordering and supervising physician must be the same person

Recent CMS "clarifications" on "incident-to" billing have muddied the waters even further.

Late last year, 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 1500 form.

CMS: 'We Take It Back'

CMS has recently sent out a notice that it has withdrawn Transmittal 20. The agency issued Transmittal 20 "in error," and there's no target date to issue a new one, according to a CMS spokesman. You'll no longer be able to find the transmittal on the CMS Web site, and the agency has also rescinded its earlier incident-to transmittal, Transmittal 17.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.

The fact that CMS has withdrawn a transmittal doesn't mean that providers will stop following the advice in that transmittal, says Theresa Powers, a consultant with Doctors Management in Knoxville, Tenn. If CMS wants providers to stop following the "great policy" outlined in Transmittal 20, then it'll have to tell them explicitly to follow a different approach.

Play It Safe

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, says consultant Jan Rasmussen, CPC, with Professional Coding Solutions in Eau Claire, Wis. You should never claim that a doctor was supervising incident-to services when she was actually on vacation, 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, Rasmussen says.