NP Visit with change in care plan

Per Medicare, if NP see's patient but there is a change in care plan - eg: new medicine started, or abnormal test result, it cannot be billed as incident too. But if I'm in the office, and see the patient also, what part of the encounter has to be performed and documented by me, the MD?

Do I have to do all the Hx/Px/MDM and document the entire encounter or can my NP finish it up. I'd like my NP to do the entire note, regardless of encounter level 99213 or 99214 and then I review and sign the note and most importantly bill under the MD.

re: NP Visit with change in care plan

You must do the HPI and the physical and medical decision making. The NP can do ROS, PFSH and vitals (reviewed by you). You cannot do it as you state. Otherwise, it becomes an NP service, billed only by NP.

re: NP Visit with change in care plan

If the visit does not meet the requirements of incident to (part of your plan of care) then have the NP document and bill under the NPs provider number. I know there is a 15% payment differential.

Incident to is a Medicare rule, sometimes Medicaid but that varies by state.