General Surgery Coding Alert

Question: A physician assistant (PA) or a nurse practitioner (NP) is treating a patient incident-to a physician who earlier saw the patient for a catheter insertion. If, during the PAs interaction with the patient, the PA makes an additional diagnosis (urinary tract infection), does the physician need to see the patient again to substantiate the new diagnosis? Could we bill the earlier service as incident-to?

Mississippi Subscriber

Answer: This type of situation is why PAs and NPs should have their own Medicare provider identification number (PIN). If they have their own Medicare PINs, you have two options in this case.

If billing incident-to, the physician would have to see the patient again to substantiate the nonphysician practitioners (NPPs) urinary tract infection diagnosis. Make sure the record demonstrates that the physician did this. Because this is incident-to, you would be billing under the physicians Medicare number.

The other option is to have the NPP perform a urinalysis and bill the service under his own Medicare number. In this case the service would not be incident-to and the surgeon would not need to be further involved.