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Q:

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AAC -Incident-to Billing
AAC - Incident-to Billing
Nurse Practitioner
In billing incident-to, please help define "new problems". For example, if a patient has a chronic health problem such as COPD with recurrent episodes of acute bronchitis, is each episode of acute bronchitis considered a new problem or can a NP bill incident to if the supervising physician has treated the patient for past episodes of acute bronchitis?

A:

In this case, the acute bronchitis would be considered a new problem, even though for this particular patient, this is a common occurence. Any acute problems experienced by patients with chronic illnesses will be considered new problems. The acute problems would require treatment specific to the acute illness' symptoms and a plan of care specific to that illness.

For Medicare purposes, the NP would not be able to bill "incident-to" in these situations. The NP would have to bill under his/her own provider number, and reimbursement would be 85% of the Medicare allowable.

 

Mary Beth Black, CPC
Senior Associate

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