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Counseling & Coordination of care rendered by NP under incident to

Luz Posted Fri 15th of May, 2015 09:53:08 AM

Patient is seen by the NP only and more than 50 percent of the visit was counseling and coordination of care. Can this service be billed as incident to the physician service?

SuperCoder Answered Mon 18th of May, 2015 00:44:57 AM

If the NPP provide the service without supervision, the services are not billable incident to the physician. In this situation, the service must be reported using the NPP’s NPI. The service may not be reported with a physician’s NPI because the physician is not providing direct supervision.

To be considered ""incident to" the NPP's service must be provided during a course of treatment where the physician performs an initial service [Emphasis added] for the patient’s diagnosis/problem and subsequent services of a frequency which reflect his/her active participation in and management of the course of treatment. Furthermore, the physician must provide direct supervision of the NPP’s service.
Direct supervision in the office setting does not mean that the physician must be present in the same room with the NPP; however, the physician must be present in the office suite and immediately available to provide assistance and direction throughout the time the NPP is performing services.

For NPP services outside the office setting, e.g., in a patient’s home or in an institution (other than hospital or SNF), the NPP’s services are covered incident to a physician’s service only if there is direct supervision by the physician. For example, if an NPP accompanies the physician on a house call and evaluates a patient, the NPP’s services are covered incident to. This means the service can be reported using the supervising physician’s national provider identification number (NPI). This service will be paid as if the physician personally performed the service.

Services provided by auxiliary personnel in an institution (e.g., nursing, or convalescent home) present a special problem in determining whether direct physician supervision exists. The availability of the physician by telephone and the presence of the physician somewhere in the institution do not constitute direct supervision and cannot be reported incident to. In the office setting, to be considered incident to, the NPP’s service must meet all of the following criteria:
• The patient must be an established patient to the practice;
• The patient’s condition must have previously been diagnosed by the physician (or a physician in the group practice) and a treatment plan already established; and
• The billing physician must be physically present in the office suite.
If all of the above criterion is not met, the service must be reported using the NPP’s NPI.

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