Wiki Billing for a Shared Service / Incident To

[lrbundy]

I am looking for help on this subject.

We do annual wellness visits in our office and also address other ongoing conditions. We have currently been billing the AWV + E&M with a 25 modifier.
Some of the patients will see the MD for the AWV but want to see there regular provider (NP, PA etc) for the other ongoing conditions.
This is fine but they want to be seen on the same day as the AWV so they do not have to come back.
Would it be ok to bill the AWV under the MD, then on a separate claim (NP, PA) bill the incident to and use the Modifier 25
Or would we be able to bill a shared service?

Any help would be appreciated.

 

[thomas7331]

This question is addressed by Medicare - see page 3 on the link below:

https://www.cms.gov/Outreach-and-Ed...N/MLNProducts/downloads/IPPE_AWVQuestions.pdf

The Initial Preventive Physical Examination (IPPE) and Annual Wellness Visit (AWV) have their own respective benefit categories. Therefore, they do not fall under the incident to benefit category.... the AWV is not subject to "incident to" rules. Therefore, where a wellness visit is performed by a "team of medical professionals working under the supervision of a physician" it is the supervising physician who will bill Medicare Part B for the visit.

The E&M service on the same day would be either billed by the PA or the MD depending on whether or not the 'incident to' requirements were met for that particular service - it should not be necessary to bill it on a separate claim. If billed with the NP or PA credentials, a modifier 25 should not be necessary since in that case the service is by a different provider and Medicare does not assign a specialty to NPPs, so it would not bundle with the AWV.