Neurology & Pain Management Coding Alert

Assume that ordering and supervising physician must be the same person

Neurology practices that have been following CMS' recent clarifications on "incident-to" billing should now be sure that the ordering and supervising physician are the same for all incident-to services billed.

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CMS has recently sent out a notice that it has withdrawn Transmittal 20.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 You'll no longer be able to find the transmittal on the CMS Web site - and the agency has also rescinded its earlier incident-to transmittal, Transmittal 17.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The fact that CMS has withdrawn a transmittal doesn't mean that providers will stop following the advice in that transmittal, says Theresa Powers, a consultant with Doctors Management in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 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, Rasmussen says.