Wiki Incident to billing at urgent care clinics?

[MnTwins29]

I am currently doing an incident-to billing audit for our primary care offices and the CEO has asked me to extend this to our urgent care centers since there are NP's who treat patients. If I understand the MCR guidelines correctly, this would not be applicable since incident to services are "commonly" furnished in physician offices. Plus, the very nature of urgent care would not seem to lend itself to incident to services - if the patient sees Dr. A the first visit and there is a treatment plan, it is unlikely that the next visit by the patient when treated by FNP B would be for the same condition. Thoughts???

 

[Walker22]

You are correct. An MD/DO must see the patient first and set a treatment plan, then the follow-ups can be billed incident-to as long as there are no new problems to address. Also an MD must be in the building when the patient is seen.

 

[OCD_coder]

Incident to requires the supervising physician to be "in the suite", not in the building.

In the building could have too many variables, such as a scenario where a hospital owned clinic and when the provider could be a surgeon and in the OR (same building technically) while the midlevel is providing services in the clinic.

The provider must be available for immediate patient attention. So please be cautious about "in the building" status of the provider.

 

[Walker22]

You are correct. My wording was imprecise. My apologies.