Orthopedic Coding Alert

Question: One of our physicians treated a patient for a sprained ankle, and a week later the patient returned for her follow-up. A nurse practitioner treated the patient, and we want to bill the service "incident-to," but that particular physician was not in that day another physician was. Can we still bill this incident-to? And if so, under which physician's number should we bill the service?

Maine Subscriber

Answer: Although some coders disagree about this, you should bill the service using the "physically present" physician's identification number.

Medicare allows you to bill services incident-to a physician even if the service is a follow-up to a service that a different physician provided in other words, you can bill incident-to Dr. X even if Dr. X has never seen this particular patient, as long as you meet the other incident-to requirements.

Billing under the number of the doctor who is in the office is best because, should you be audited, you will be able to prove that this doctor was present that day and was providing the necessary supervision. If you bill under the original doctor's number, you won't be able to prove that he was there (because he wasn't).