Ob-Gyn Coding Alert

Question: How should I code incident-to when our physician is in the office? What modifier should I use when our ob-gyn 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 who performs/supervises an encounter. To indicate that the service meets Medicare's incident-to criteria, you should report the service using the ob-gyn'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. What this means: The physician must be present in the office suite and immediately available to furnish assistance and direction, but the physician does not have to be in the room where the patient undergoes the test.

When an NP performs a service without the ob-gyn'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.