Pulmonology Coding Alert

Don't take unnecessary risks for 15 percent more pay. Incident-to rules don't always apply to diagnostic services, but many medical practices aren't aware of that. And based on new scrutiny directed toward incident-to claims, you should know the incident-to rules inside and out. The Office of the Inspector General's (OIG's) recent discovery that unqualified nonphysician practitioners (NPPs) performed 21 percent of incident-to services is sure to have Medicare scrutinizing your incident-to claims very carefully. Although the OIG would like to apply a quick fix to the incident-to reporting issues that practices have faced, CMS acknowledges that appending an "incident-to modifier," as done in the distant past, wouldn't be a cure-all. "A modifier or series of modifiers might at some point be part of an overall solution, but right now it isn't the only solution," says Joan Gilhooly, CPC, PCS, CHCC, president of Medical Business Resources. "CMS first needs to debunk [...]