Date: 01/31/2003
Q:
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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