Outpatient Facility Coding Alert - 2022 Issue 12
Reader Questions: Remember New Patients are Never Incident-To
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Article Overview
This reader Q&A explains general incident-to billing concepts in a Medicare context, with emphasis on when a visit does or does not fit the incident-to framework. It is aimed at coders, billers, and compliance staff who need to understand how patient status, physician involvement, and treatment continuity affect reporting decisions.
Why This Topic Matters
Incident-to billing rules can affect whether services are reported under a physician or nonphysician practitioner. Understanding the basic scope of these rules helps avoid billing errors and supports compliant office visit reporting.
What You Will Learn
- How incident-to concepts apply to office visits in a Medicare context
- Why patient status affects whether a service fits incident-to reporting
- How new problems differ from ongoing follow-up care in this setting
- What general physician involvement is described as relevant to incident-to reporting
Who Should Read This
- Medical coders
- Medical billers
- Compliance staff
- Practice managers
- Nonphysician practitioner billing staff
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