You Be the Coder: Know How to Avoid This Incident-to Error

Why This Topic Matters

Misapplying incident-to requirements can lead to incorrect Medicare reporting for routine office visits. Understanding the supervision and patient-status context helps practices avoid billing errors for nurse-performed services.

Article Sections

1. Question

   A reader asks about billing a Medicare nurse visit when the physician was not physically present in the office. The scenario sets up a concern about whether the reported service is appropriate under Medicare rules.

2. Answer

   The response explains the Medicare context for the service and discusses the general supervision and patient-status conditions tied to the office visit. It also addresses how the encounter fits within the incident-to framework and how the service is associated with supervising provider information.

3. Get the scoop

   This section defines the incident-to concept in broad terms and relates it to a prior visit and an ongoing treatment plan. It focuses on the relationship between the earlier assessment and the follow-up service.

4. Important

   The final section explains how supervision is connected to the day of service and the reporting of encounter information back to the physician. A short example illustrates the general workflow for the follow-up office encounter.