Incident-to with new problem

Can you please help me clarify this. When an NP or PA is treating an established patient (Medicare) with an established problem but the patient also has a new problem, how do you handle it? I have read that it would have to be billed under the NP/PA's NPI # because a new problem does not qualify for incident-to, but I have also read from multiple sources that you can treat it like a shared/split visit in the office where the physician goes in and treats the patient for the new problem and the NP/PA goes in and treats the patient for the established problem, then you can bill it as incident-to because the phyisican established the plan of care for the new problem and the NP/PA only treated the established problem. I know this way seems like a waste of physician time, but I do know some physicians who utilize their NP/PA services in shared/split visits in the office setting everytime and that is why this is such a big deal for me.

Please help!!
Thanks!

Incident To

This would have to be the responsibility of the physician, billed and performed by the physician. If a new problem arises that has not been evaluated and a treatment protocol established for the problem (condition) there is no "incident to". I have not read otherwise from CMS, and this is a Medicare policy.

Incident-to new problem

Ok, now I am a little more confused. Does the scenario change at all if the NP/PA is the one who treated the patient first on the visit. Such as the NP/PA sees the patient and documents all of the E/M elements except MDM then the physician comes in and documents the MDM. I was always under the impression that if the NP/PA has any involvment in the visit and then it has to be billed under the NP/PA's NPI number no matter if the physician sees the patient or not, if the visit does not meet incident-to requirements. That is why I was so thrown off by these other sources saying they could share/split the visit and it would qualify for incident-to.

incident-to

AN NP or PA CANNOT BILL "INCIDENT-TO" ON A NEW PATIENT, THEY CAN BILL UNDER THEIR OWN PROVIDER NUMBER AND REIMBURSEMENT IS REDUCED TO 85% OF THE ALLOWED. STATE LAW "SCOPE OF PRACTICE" MUST BE FOLLOWED.

incident to

There are three or four articles in the Codapedia encyclopedia on this topic, which explain all the what if's pretty well. In the search box, above Look it up! type in "incident to." You'll find:

Incident to services for Medicare Patients
Can a physicians assistant do a consult

among others.

New patient or new problem: bill under NPP

If the NPP saw the patient first for that problem, all follow ups are billed under the NPP.

Read the requirements for incident to, that is, billing under the MD's number in the first article.