Can a physician bill incident-to services if the NPP sees the patient for a new problem?

When considering whether a physician can bill for incident-to services when a Non-Physician Provider (NPP) sees a patient for a new problem, it's essential to understand the definitions and regulations surrounding incident-to billing. Incident-to services allow a physician to bill for services provided by an NPP as if the physician had performed them, provided certain conditions are met.

For incident-to services to be billed, the NPP must provide care that is an extension of the physician's established treatment plan. Typically, this means that the patient should already have an established relationship with the physician for a particular condition, and any services rendered by the NPP must relate to ongoing treatment for that condition. When an NPP sees a patient for a completely new problem, that scenario falls outside the physician's existing treatment plan since the NPP is addressing an issue that hasn't been previously managed or accounted for by the physician. Therefore, it is not appropriate to bill incident-to for that encounter.

Consequently, option B accurately reflects this requirement: the inability to bill incident-to services arises because there is no established treatment plan from the physician related to the new problem being addressed by the NPP. Proper documentation and prior knowledge of the patient's condition by the physician do not change the fundamental