Neurology & Pain Management Coding Alert

Question: How should I code incident-to when our physician is in the office? What modifier should I use when our neurologist is not in the office and the nurse practitioner (NP) sees a patient by herself?

Colorado Subscriber

Answer: Provider identification numbers (PINs), not modifiers, tell payers about an encounter's performer/ supervisor. To indicate that the service meets Medicare's incident-to criteria, you should report the service using the neurologist's PIN. The claim is blind as to whether an NP or physician performed the service, so payers reimburse the claim at 100 percent.

Remember: Incident-to implies that the nurse practitioner provided the services under a physician's -direct supervision- following an established plan of care.

When an NP performs a service without the neurologist's direct supervision, following an established treatment plan or evaluating a new problem or complaint, you instead report the code under the NP's PIN. You should use the same procedure codes as with incident-to.

Caution: Before allowing your NP to provide services without direct supervision, make sure your state scope-of-practice and licensure laws permit doing so.

You might be confusing teaching facility supervision with physician supervision. In a teaching facility, you indicate the teaching physician's involvement with these modifiers:

- GC -- This service has been performed in part by a resident under the direction of a teaching physician

- GE -- This service has been performed by a resident without the presence of a teaching physician under the primary-care exception

- GR -- This service was provided in whole or in part by a resident in a Department of Veterans Affairs medical center or clinic, supervised in accordance with VA policy.