tci E/M Coding Alert - 2022 Issue Q3

Reader Questions: Remember Incident-To in Office Setting, per Medicare

Question: The primary care practitioner (PCP) and the nurse practitioner (NP) both saw a patient during a follow-up visit. The notes in the patient record say that the PCP performed the physical exam, the NP interviewed the patient regarding history, and they both partic­ipated in medical decision making. The NP’s record of events matches that of the PCP, and the PCP signed it. In time spent, the PCP spent more than half the total time with the patient, and performed the substantive portion of the service, yet a colleague is telling me we can’t bill for...

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