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Orthopedic Coding Alert

E/M Coding:

Take These Steps Before Considering Incident-To

Published on Mon Feb 21, 2011

Established plan of care a must to bill under physician's NPI.Orthopedic practices that are not taking advantage of Medicare's incident-to billing opportunities are missing out on a valuable revenue stream.How? If an encounter meets all of the parameters for incident-to billing, you can report the service under the physician's national provider identifier (NPI), gaining full pay for the encounter. Without incident-to, you have to report the same service under the nonphysician practitioner's (NPP's) NPI, which pays out at 15 percent less than the physician's.15 Percent Per Patient Can Add UpThe $kinny: Let's say that a qualified NPP provides a levelfour E/M service for a patient with . The visit meets all of the incident-to parameters, but you report 99214 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: a detailed history; a detailed examination; medical [...]
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