FOR MEDICARE ONLY….WHAT MODIFIER TO WE PUT ON XRAYS DONE IN THE OFFICE WHEN BILLING UNDER A NURSE PRACTIONER, NOT INCIDENT TO? 26 OR TC?? WE HAVE BEEN PUTTING TC ON THE XRAYS WHEN BILLING OUR NURSE PRACTIONERS AS THEMSELVES BUT FOUND SOMETHING THAT SAID IT SHOULD BE 26? I THOUGHT THAT WAS ONLY FOR IF THE DOCTOR READ IT…..NOW WE ARE NOT SURE. JUST WANT TO GET IT CORRECT. PLEASE ADVISE WITH ARTICLES IF YOU CAN. :confused:
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Tag Archives: Incident
Incident to question
While reading an AAPC article https://www.aapc.com/blog/31665-lets…ing-incident-4
scenario 2 "A physician performs the initial evaluation, develops a diagnosis, and develops the care plan. Auxiliary personnel perform subsequent follow-up services. The physician, however, is not on the premises. Instead, an NP/PA supervises performance of the services by auxiliary personnel.
scenario 2 "A physician performs the initial evaluation, develops a diagnosis, and develops the care plan. Auxiliary personnel perform subsequent follow-up services. The physician, however, is not on the premises. Instead, an NP/PA supervises performance of the services by auxiliary personnel.
For this case even if all other criteria under the incident-to rule were satisfied the service cannot be legitimately reported under the name/NPI of the NP/PA. The most obvious reason is because the NP/PA did not initiate the care; therefore, the auxiliary person is not performing a service that is integral although incidental to the NPs/PAs professional service. As a result, the authority in the coverage rules for NPs/PAs, which are conditioned on compliance with §410.26, would not be satisfied.
Depending on your state, compliance with §410.26 requires that the auxiliary personnel are permitted under applicable licensure rules to perform the service under an NPs/PAs supervision. As delegation authority is not commonly found in most NP/PA licensure rules (and where its found, its extremely limited), its possible that such a delegation would not be permissible. As a result, the requirements of §410.26 would not be met."
This hit home to me because I have this situation. 1 coworker states ok to bill with the Dr. NPI as incidental because the PA can’t be the supervising physician, and other states because the PA didn’t initiate the initial evaluation they are disqualified as supervisor for the auxiliary massage therapist and to write the visit off. Help please…
Dena W. CPB
Medicaid Incident to?
Does anyone know if Medicaid follows Medicare’s incident to rules? Or if perhaps they have their own? I believe that Medicaid recognizes the SA modifier, but I want to make sure we follow any guidelines Medicaid has and not only worry about Medicares.
Incident to Scenario- Please help
Hi,
We need guidance on the below scenario. Our doctor evaluates patient at first visit, second visit the NP follows treatment plan with same dx (bills incident to), then a psychologist treats patient with a new dx, then the NP follows up with patient after psychologist and adds the new dx code given by the psychologist. Can the first doctor add an addendum onto the psychologist note stating that she has reviewed the treatment plan? Would that allow the NP to bill incident to with the new diagnosis that the psychologist has given because the first doctor reviewed and did an addendum to the doctor psychologist note? Or can the doctor do a separate note stating that she has reviewed the psychologist note and agrees/decides on the new dx code as a revised plan of treatment? Any advice would be helpful.
Thank you in advance.
Micki
Billing incident to Bill for on-site Pharmacy
I am wondering if anyone has had any experience about billing for on-site pharmacist claims, billed under "incident to" physician claims. Such as medication management, smoking cessation, weight management, etc. Any information is helpful. thank you.
Incident to Medicare Part C and TriCare
Does anyone know how to obtain documentation to show Medicare Part C does NOT apply incident to guidelines? It shows Part B follows incident to, but could not find anything about Part C. Also if anyone has clarity if TriCare follows incident to or not. I could not find documentation for TriCare that says yes or no to follow incident to guidelines. Thank you for any help!
Incident to and New patients
I am from South Dakota and most of the time our PAs will see the new patients. After our PAs have taken most of the HPI and exam, the Dr will then go in the room and decide on a plan. The PA dictates the encounter and in the MDM says Patient was seen by both myself and Dr. _____ on today’s visit. And then dictates if the patient will be started on a med, surgery, or any work up. Is this enough information to bill under the drs name for medicare patients?
Here is an example for MDM that was dictated by a PA
IMPRESSION:
1. Painless gross hematuria.
2. History of recurrent urinary tract infections.
RECOMMENDATIONS/PLAN: Patient was seen by both myself and Dr. _____ on today’s visit. We discussed today with ______ the process of finishing her hematuria workup which include cystoscopy with bilateral retrogrades and bladder washings under MAC anesthesia. This will be accomplished in our office. She will have preoperative H&P as well.
Then this is documented by dr.
I have examined and interviewed the patient and confirm the pertinent findings. I have discussed the case with _____, PA and agree with the pertinent findings and plan.
Incident to billing scenario
A nurse practitioner sees a Medicare patient for the initial visit and sets up a treatment plan, billing under them at 85%, because there was no supervising physician on-site. The patient returns for a second visit to see the nurse practitioner, but this time there is a supervising physician on site. Can that second visit be billed as incident to even though the patient has never seen the physician and the NP set up the initial treatment plan? Thanks.
Incident to billing/coding
At my facility we are going to start billing "incident to" for a PA that is going to be working in our urgent care and possibly eventually move into our family practice. I have been researching the guidelines and brought them to my CEO. My question is: do the guidelines only apply to Medicare patients? Also can you only bill "incident to" for Medicare patients? Or does this apply to ALL payers regardless? My management stated that we can bill "incident to" for anyone, and the only time the guidelines need to be followed is when it’s a Medicare patient.
Also is there any work that the supervising physician has to do when we are using that MD’s NPI for billing?
Also is there any work that the supervising physician has to do when we are using that MD’s NPI for billing?
Any clarification on this would be helpful as I am lost and do not feel what I am being told is necessarily true.
Thank you,
Nicole Stettner, CPC
Coding Analyst
Confront An Emergency Medical Incident With Emergency Medical Alarms
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Suppose one of your elderly family member is all alone at home and suddenly falls and is unable to get up. Since he is all alone at home help cant be made available and since he is unable to get up he
cant even call for help from the telephone or the mobile. Such conditions can really raise serious consequences. So for such individuals who are subjected to similar medical conditions, the elderly alert devices can really prove very useful. All they have to do is press the emergency button over the medical alert pendant and the whole system gets activated and the user is connected to the emergency response center via a communication line.
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