Wiki incident-to visit with new problem

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trarut

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Any incident-to pros out there? I recall that a nurse practitioner (NP) cannot see a patient with a new problem when billing incident-to but I have a bit of a twist that I need some advice on. Our NP is not credentialed and bills only incident-to.

Scenario: An established patient presents for follow-up with the NP for follow-up of breast cancer but in the course of the visit, it becomes apparent that the patient has a new onset problem of stumbling & altered gait. The NP assesses the patient and determines they can proceed with the next cycle of chemotherapy (per the established treatment plan). CT of the brain is ordered by the NP to assess the stumbling and altered gait.

:confused: Does the new problem render the entire visit non-billable? Can we code and bill the incident-to portion of the visit, not giving credit for anything related to the new problem?

This has a couple of us stumped and we just can't seem to find a definitive answer. Thanks for reading!
 
I assume this is a Medicare patient since the term, 'incident to' is Medicare only. Non-Medicare payers may have different guidelines. Having said that...I believe it's ok to bill for only that portion of the evaluation that complies with 'incident to', but I would document this in the patient's billing note to protect against any audits. It will appear questionable, so it should be clear the NP is not billing inappropriately. I would only do this as a last resort and educate staff to effectively screen patients.
 
Thanks for the response. Yes, most of the ones we've identified for our new NP are Medicare and we are working on the staff education.
 
Thanks for the additional information. Clearly, this is a completely new area to me and I want to make sure we're doing this correctly.

Tracy
 
I am dealing with a specialty practice where the P.A. is seeing ALL pts under the Dr's NPI(Medicare and all commercial) - new pts, follow ups with new problems, etc. I have tried to tell the physician that the P.A. has to bill under their own NPI as this is not incident to. The physician says "well, I "pop in" the room while the PA sees the pt. Am I correct - this is not sufficient to change this type of scenario to "incident to" ?
 
you are correct, he is referring perhaps to the shared service regulation (CR1776). However you cannot share a new patient, and to bill as a shared service the provider that "pops" in must document their own specific piece of the encounter indicating that they had a face to face examination of the patient and they have read the NPP's documentation and agree or disagree with the findings. This cannot be a one line addendum nor just their signature. CR1776 states
If the there is no face to face encounter (documented) between the provider and the patient, even if the providers signs off on the documentation of the NPP, then the visit musgt be billed using the NPP's NPI number.
Also you are correct that you cannot separate out the portion of the encounter that complies with incident to, it is the entire visit or nothing.
I would also like to add that the incident to regulation is not necessarily just for Medicare, many other payers adopt Medicare policy as their own, the AMA has stated that if a payer 'tells" you they do not follow Medicare on incident to , that you must get it in writing from them with the clear understanding that they acknowledge that this patient may have never attended this patient for this issue and may be out of the building during the encounter.
 
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