Part B Coding Coach: Want to Make an Extra $8 Each Time You Report 99213?

Why This Topic Matters

Correctly understanding incident-to billing can affect claim submission, payment level, and compliance for office-based E/M and procedure services. The article is relevant to practices that want to distinguish when a service belongs under the physician’s billing versus the practitioner’s own billing number.

Article Sections

1. Incident-to billing overview

   Introduces the Medicare billing topic and the general circumstances in which services may be reported under a physician’s number rather than the practitioner’s own number.

2. Requirement 1: Employees belong to the same group

   Discusses the employment relationship expected between the supervising physician and the non-physician practitioner in a group setting.

3. Requirement 2: The physician initiates treatment

   Covers situations where prior physician involvement affects whether a service is billed under the physician or the practitioner. Includes a new-patient scenario and related office visit guidance.

4. Requirement 3: The NPP treats an established problem

   Explains billing considerations when a practitioner provides care for a problem that has already been established in the physician’s treatment plan. Includes an example involving chronic disease management and a separate change-in-condition scenario.

5. Requirement 4: Care involves the physician

   Addresses the need for ongoing physician participation in the patient’s care and references carrier interpretation of continued involvement.

6. Requirement 5: Your physician provides direct supervision

   Describes the supervision setting expected for incident-to billing and discusses how the supervising physician in the office suite affects claim reporting. Includes a procedure example.

7. Additional reporting note

   Provides a brief reminder about reporting when multiple physicians are present and identifies a source for obtaining related educational material.