Psychiatry Coding & Reimbursement Alert

Published on Fri Feb 14, 2014 PDF

Question: I have a case where one physician (physician A) in my practice covered an established patient office visit for another physician (physician B) in the practice because physician B had to run across the street to see a patient in the hospital. They want me to bill the office visit incident-to physician B even though he was not in the office at the time. Is this okay?

Tennessee Subscriber

Answer: You should not report this service incident to physician B.

Incident-to billing doesn’t apply between two physicians. You cannot bill services provided by one physician under another physician’s name or national provider identifier (NPI) using “incident to” rules. Billing under the name of a physician who did not perform the service could lead to allegations of false claims submissions.

Incident-to billing may apply when a mid-level provider or non-physician practitioner (NPP), such as a physician assistant (PA), nurse practitioner (NP), or clinical nurse specialist, provides a service under the direct supervision of a physician. If the service meets “incident to” criteria, you can bill the service under the physician’s NPI rather than the NPP’s.

In this case, physician A should bill for the service using his NPI.