Urology Coding Alert

Question: How do we bill under incident to if the patients physician is not in the office but a different physician is? Also, when a nurse or a physician assistant (PA) provides a Lupron injection, how should we bill?

Alabama Subscriber

Answer: Regarding your first question, if the physician who is on-site is a member of the practice, it doesnt matter that the patients physician is not. Medicare looks at a group practice as a single physician for payment purposes. Bill under the patients physician as if he or she were on-site.

To answer your second question, for Medicare or private payers, bill under the name of the physician who is present in the office at the time of the Lupron injection. If the patients own physician is not present in the office, you cannot bill under his or her name, but only under the name of the physician who is present. The physician who is doing the supervision should sign the note (if one is needed by your carrier). No special notification is needed on the insurance form when a nonphysician provider provides the service as incident to.