Posted on 20. Oct, 2009 by in Hot Coding Topics
Heads up: These vaccine admin codes are excluded from incident-to requirements.
Incident-to rules don’t always apply to diagnostic services, but many medical practices aren’t aware of that.
And based on a new wave of scrutiny directed toward incident-to claims, you should know physician supervision rules inside and out.
A recent audit from the HHS Office of the Inspector General audit found that unqualified nonphysician practitioners performed 21 percent of incident-to services examined, and that’s sure to have Medicare scrutinizing your incident-to claims even more thoroughly than in the past.
The presumption: Many practices believe that as long as they meet the minimum requirements of incident-to (the physician is on-site and sees patients for any new problems), they can report all types of NPP services incident-to and collect their extra 15 percent of Medicare reimbursement.
In many cases, “physicians feel as long as they can just simply peek in or sit somewhere nearby, they’re covered by these rules,” unaware that there is more to it for the different types of services these offices perform, suggests Leslie Johnson, CPC, coding supervisor for Duke University Health System and owner of the billing and coding Web site AskLeslie.net.
The reality: “There needs to be a certain level of ongoing involvement,” Johnson says. “Coders, billers, and physicians are confused. They may not know the rules, and may be confused by the terminology ‘incident to.’”
For example: Many practices aren’t aware that the regulations exclude flu (G0008) and pneumonia (G0009) vaccine administration from the incident-to requirements, but require that incident-to rules be met for the hepatitis vaccine (G0010) when covered, Gilhooly explains.
Plus: The incident-to rules don’t always apply to diagnostic tests, which are governed by separate supervision requirements. “In the Medicare fee schedule, you can find the supervision indicators that describe...
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