General Surgery Coding Alert

Question: Should I use a modifier when reporting services provided incident-to the surgeon's care?


Utah Subscriber
 

Answer: No, you don't have to append a modifier of any type to identify incident-to services. Rather, you should report incident-to services just as if the physician performed the service himself. When billing incident-to services, however, you should keep in mind these three facts:

1. To bill a service incident-to, you need physician supervision from somewhere in the office space. To document this, you need at least a simple phrase in the progress notes such as "performed under the supervision of Dr. X," or "service provided under supervision of Dr. X."

Failing to document physician supervision could lead to a government audit. And even though your physicians may be able to show the auditors their schedules and prove that they were in the office at the time, it's still a time-consuming - and therefore costly - hassle that you can easily avoid with better documentation.

2. You cannot bill incident-to services for new patients or for established patients with new problems. Rather, to report nonphysician practitioner (NPP) services incident-to a physician, you must provide the services to an established patient with an established plan of care. If an NPP sees a patient for any other reason, the service must be billed under the NPP's provider number.

3. All services the NPP provides must be within the NPP's scope of practice as defined by your state.