Wiki Billing for Nurse Practioners Incident-To - symptom of weakness

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lillianivy

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:confused:We have Nurse Practioners (NP)who see pts as follow-up care and work-ins. We are trying to determine the fine lines of incident-to. A Physician is always in the office when a pt is seen by a NP.

Scenario 1:
Pt comes to clinic for follow-up care with no new complaints. During the visit the NP reviews the labs and a new dx is determined per the labs and a new drug/treatment plan is given. IE.. pt now with chemo induced anemia and Procrit is ordered. So the initial plan of care as been altered and the physician did not have a face-to-face encounter with the pt and the physician did not sign the record nor made an entry, is this visit no longer an incident-to visit and can now be billed under the NP?

Scenario 2:
Pt comes in for new symptom of weakness, and N/V due to chemo(work-in). Pt only sees NP and fluids are ordered and Zofran prescription given. Physician does not have a face-to-face with pt and did not sign record. Is this not an incident to and can be billed under the NP?

Scenario 3:
Same as scenario 2 but physician does have a face-to-face and makes an entry in the record and signs record. Bill under physician? Does Physician need do all 3:
1. Have a face-to-face
2. Make an entry in record
3. Signs record
Or can the NP make an entry stating(Then sign record alone):
"Dr. Smith saw pt with me and created Plan of care."

Scenario 4:
Pt has follow-up with NP. No new complaints. No change in plan. Prescriptions refilled. Continuous labs ordered and follow-up radiology test ordered. Is this considered incident-to? Physician is in office but did not have a face-to-face encounter with the pt and the physician did not sign the record nor made an entry. Therefore, bill under physician.

Scenario 5:
Pt has follow-up with NP after Initial visit with the physician where treatment plan was created. NP does a Chemo teaching visit. Is this considered incident-to? Physician is in office but did not have a face-to-face encounter with the pt and the physician did not sign the record nor made an entry. Therefore, bill under physician?

Scenario 6:
How NPs are educated in Genetic Counseling and Survivorship Counseling. They see pts in addition to treatment, ect. The physician does order it in last visit, but during this encounter the pt only sees the NP. Therefore, bill under NP?

Please Help!! Need clarification.

Thank you,
Lydia
 
Scenario 1:
Pt comes to clinic for follow-up care with no new complaints. During the visit the NP reviews the labs and a new dx is determined per the labs and a new drug/treatment plan is given. IE.. pt now with chemo induced anemia and Procrit is ordered. So the initial plan of care as been altered and the physician did not have a face-to-face encounter with the pt and the physician did not sign the record nor made an entry, is this visit no longer an incident-to visit and can now be billed under the NP? Since the physician did not evaluate the patient for this dx in a previous encounter, this visit must be billed using the NP NPI.
Scenario 2:
Pt comes in for new symptom of weakness, and N/V due to chemo(work-in). Pt only sees NP and fluids are ordered and Zofran prescription given. Physician does not have a face-to-face with pt and did not sign record. Is this not an incident to and can be billed under the NP?again the physician has not previously evaluated this patient for these symptoms, bill using NP NPI
Scenario 3:
Same as scenario 2 but physician does have a face-to-face and makes an entry in the record and signs record. Bill under physician? Does Physician need do all 3:
1. Have a face-to-face
2. Make an entry in record
3. Signs record
Or can the NP make an entry stating(Then sign record alone):
"Dr. Smith saw pt with me and created Plan of care."
this is a shared encounter if this is an established patient and can be billed using the physician NPI. Yes the provider must perform all three elements.
Scenario 4:
Pt has follow-up with NP. No new complaints. No change in plan. Prescriptions refilled. Continuous labs ordered and follow-up radiology test ordered. Is this considered incident-to? Physician is in office but did not have a face-to-face encounter with the pt and the physician did not sign the record nor made an entry. Therefore, bill under physician.
since the patient has been evaluated for this dx by the provider in a previous visit and there is (I assume) an order for the patient to return for follow up, and the provider is in the office, this visit qualifies for incident-to and may be billed using the physician NPI
Scenario 5:
Pt has follow-up with NP after Initial visit with the physician where treatment plan was created. NP does a Chemo teaching visit. Is this considered incident-to? Physician is in office but did not have a face-to-face encounter with the pt and the physician did not sign the record nor made an entry. Therefore, bill under physician?
as long as the plan of care from the physician includes that chemo teaching will take place, this qualifies for incident to and may be billed under the physician NPI

Scenario 6:
How NPs are educated in Genetic Counseling and Survivorship Counseling. They see pts in addition to treatment, ect. The physician does order it in last visit, but during this encounter the pt only sees the NP. Therefore, bill under NP? again since this was ordered previously by the physician, as long as the physician is in the office at the time of the encounter this qualifies for incident to and can be billed under the physician NPI
 
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