Wiki Billing for Nurse Practioners Incident-To

[lillianivy]

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.

Please Help!! Need clarification.

Thank you,
Lydia

 

[dtricia]

Incident To

Scenarios
The physician must see the patient first and initiate the care plan. he should inform the patient that a qualifiend practioner will be caring for him/her under the physicians direction and monitoring. "Incident to" rules do not apply if there is a new illness or problem for which the physician has not previously seen the patient and there is not an established plan of care.

The physician must be present on site. He does not have to see the patient face-to-face at each visit, nor does he have to sign the NPs notes.
The NP however must make a statement that the patient is being seen 'incident to' Dr.Smith. Billing must be done under the billing number of the physician who is actually on site providing supervisory services that day rather than the physician who initiated and provides ongoing monitoring of the patient's care.
There are likely Plans of Care established for a variety of scenarios that are common symptoms reactions to treatment regimens. Talk to your providers.