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Physician billing base on time for coordination for an incident service

Luz Posted Fri 31st of July, 2015 09:48:47 AM

My question is the following: Is it acceptable for the physician to bill based on time (40 min and more than 50% as counseling and/or coordination of care) for an incident to service with an NP? Does the NP and the physician needs to be together and both to be active participant during the 50% face-to-face counseling time time? Please direct me to any documentation regarding this question if available.

Thank You

SuperCoder Answered Mon 03rd of August, 2015 01:51:00 AM

Your query is a best example of split/shared E/M serive. You should bill this service under NPP's NPI as "When an E/M service is a shared/split encounter between a physician and a non-physician practitioner (NP, PA, CNS or CNM),the service is considered to have been performed “incident to” if the requirements for “incident to” are met and the patient is an established patient. If “incident to” requirements are not met for the shared/split E/M service, the service must be billed under the NPP’s UPIN/PIN, and payment will be made at the appropriate physician fee schedule payment." For more information, please read the article linked below. https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/r178cp.pdf

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