Ophthalmology and Optometry Coding Alert

Take this quiz to see if you should be hitting the incident-to coding books

Each time a nonphysician practitioner (NPP) provides services for a Medicare patient, you should be on the lookout for the opportunity to report the service incident-to the physician. But if you don't follow Medicare's strict guidelines for incident-to billing, you-ll only see partial payments and denials. Take this quiz to test your NPP knowledge.

Beware: Your billing will be non-compliant if you continue to bill the NPP services under the physician's NPI without following Medicare's rules. If you cannot bill for the NPP's in-office service under incident-to guidelines, you have the alternative to bill the NPP under his own NPI/PIN and receive 85 percent of the physician fee schedule allowance.

Question 1: One of your practice's nurse practitioners (NP) sees an established patient whom the physician has been treating for glaucoma. The physician has seen the patient in the recent past and has established the diagnosis and initiated treatment or a care plan. The NP performs a follow-up history and examination and continues the prescribed treatment. The physician is in the office suite but does not see the patient. How should you code this encounter?

Question 2: A physician assistant (PA) from your office sees a patient in the hospital whom your physician admitted the day before. Can you report this visit incident-to the physician?

Question 3: A new patient comes to the office complaining of recurrent headaches. One of your NPPs treats the patient and establishes a care plan for migraines. Can you bill this service incident-to the physician who was in the office suite at the time of the appointment?

Question 4: Your physician leaves the office early because he isn't feeling well. The nurse practitioner sees one more patient for a visual field test, which was planned by the physician. The patient is established with the physician, and the NP follows the established plan of care. Can you report this service as incident-to?