Primary Care Coding Alert

Question: An established Medicare patient with a plan of care in place for his uncontrolled type II diabetes reports to the practice medication check (the patient has been in frequently, as it has been difficult to decide on the proper insulin regimen to treat his diabetes). The nonphysician practitioner (NPP) performs some blood and lab work, and then discusses the results with the patient.

They decide on a new daily insulin intake, and the NPP discharges the patient; notes indicate a level-three E/M service. During the entire encounter, Dr. P was in the office suite and immediately available to assist the NPP. The patient's care plan, however, was initiated by Dr. F. Can I report this service incident-to the physician?

Minnesota Subscriber

Answer: Yes, you can code incident-to Dr. P, as he was the supervising physician for the encounter.

On the claim, report 99213 (Office or other outpatient visit for the evaluation and management of an established patient, which requires 2 of these 3 key components: an expanded problem focused history; an expanded problem focused examination; medical decision making of low complexity...) for the E/M service under Dr. P's National Provider Identifier. This will net you 15 percent more than reporting 99213 under the NPP's NPI.

Remember to append 250.02 (Diabetes mellitus without mention of complication; type II or unspecified type, uncontrolled) to 99213 to prove medical necessity for the E/M service.

Explanation: The supervising physician does not need to be the physician who initiated the patient's care plan. As long as the supervising physician (Dr. P in this instance) was in the office suite and knew that he was acting in a supervisory role, you can report this encounter incident-to the physician.