tci Medicare Compliance & Reimbursement - 2022 Issue Q4

Reader Question: Know the Facts on New Patients and Incident-To

Question: A new patient came in and the nurse practitioner (NP) took the initial history and performed the check-up. The physician was in and out of the room, and always available if needed. Is this visit billable as incident to? Ohio Subscriber Answer: No — new patient encounters are not covered under incident-to guidelines. This is because the physician must initiate treatment and see the patient regularly to show they’re actively involved in the ongoing treatment of the patient’s condition. This is not possible with a new patient because a treatment plan has not yet been established...

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