Incident To Challange

We have a challenging question about Incident to in our office.

•PA saw patient on initial visit and came up with plan of care (procedure).

•Two weeks later the procedure done by the MD. During the procedure the MD decided to stop the procedure and came up with a new plan of care.

•Week later the patient comes back for a follow up with the PA.
Can the PA bill Incident to now that the MD saw the patient and came up with a new plan of care?

(Patient has traditional Medicare)

re: Incident To Challange

Initial visit billed by PA; two weeks later visit billed by MD; Week later: was there a global period for the procedure? If not, PA can bill incident to MD service because the MD had established a new plan.

re: Incident To Challange

Is there any resource that says that?

re: Incident To Challange

Incident to the provider's professional services means that the services or supplies are furnished as an integral, although incidental, part of the provider's professional services in the course of diagnosis or treatment of an injury or illness.1 The provider can include physicians, nurse practitioners, clinical nurse specialists, certified nurse midwives, physician assistants, clinical psychologists, clinical social workers and physical and occupational therapists. The services provided must be delivered under the provider's direct supervision; the provider must be in the area where care is delivered and be immediately available to provide assistance and supervision. The provider must initiate a course of treatment and the service provided by the auxiliary staff is follow up care, assisting in providing the plan of care.
http://journals.lww.com/jwocnonline/Fulltext/2012/03001/Understanding_Medicare_Part_B_Incident_To_Billing_.5.aspx

re: Incident To Challange

Thank you!