Outpatient Facility Coding Alert - 2022 Issue 9
Reader Questions: Remember Incident-To in Office Setting, per Medicare
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Article Overview
This article explains a Medicare policy update affecting split or shared evaluation and management visits and discusses why office-based services involving a physician and a nonphysician practitioner are treated differently from institutional settings. It is written for coding and billing professionals who need to understand the general Medicare framework, including incident-to coverage concepts and where CMS guidance applies.
Why This Topic Matters
It helps readers distinguish between institutional split/shared visit policy and office-based Medicare billing under incident-to rules, which is important for compliant evaluation and management claim submission.
Article Sections
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Question
A reader asks about billing a follow-up visit when both a physician and a nurse practitioner took part in the service and documented the encounter.
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Answer
The response addresses Medicare policy changes for split or shared visits, notes the distinction between institutional and office settings, and points to CMS guidance for incident-to coverage.
What You Will Learn
- How Medicare distinguishes split or shared visits from office-based incident-to billing
- Why the place of service matters for evaluation and management claims
- Where to find CMS guidance related to incident-to services
- How physician and nurse practitioner participation is discussed in Medicare billing context
Who Should Read This
- Medical coders
- Medical billers
- Compliance staff
- Physician practice administrators
- Primary care office staff
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