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Incident To
- Does not apply in hospital
- Must be expense to physician or group
- Requires direct over-the-shoulder physician supervision
(Dr In Suite)
- Cannot See New Patients
- Cannot diagnose/treat new problem
- Physician initiates treatment plan
- Physician actively in ongoing care
- Bill any level (if NP, PA, CNS)
- Bill under physician’s name and PIN
- No reduction in payment
Incident
To |
Own
PIN |
No
New Patients |
Any
Patient |
No
New Problems |
Any
Problem |
Physician
In Suite |
Who
cares where Dr is? |
Not
at Hospital |
Any
Place of Service |
Physician
Directs Patient Care |
NPP
Direct Patient Care |
Full
Payment |
85%
of Physician Fee |
Code
at Any Level |
Code
Any Level |
Factors to Consider:
- Even if an NP’s service is non-billable,
is the NP saving the physician time so he can do other billable
services?
- Is patient care and satisfaction enhanced by
the service?
- Can more patients be seen as a result of the
team effort?
- Is income increased by efficiency?
- Is there a reduction in adverse events?
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