Cardiology Coding Alert

Use NPPs and stop forfeiting $$$ for missed cardio consults and procedures If your cardiologist is overloaded with admits, discharges and rounding, you can use Medicare's shared-visit provision when your practice's nonphysician practitioners (NPPs) lend a helping hand.  But make sure your physician personally documents face-to-face patient encounters. Let NPs Get the Ball Rolling on Admits, Discharges "The shared-visit provision has made hiring nurse practitioners and physician assistants a lucrative opportunity for cardiology groups," says Jim Collins, ACS-CA, CPC, CHCC, a cardiology compliance consultant with Compliant MD Inc. in Matthews, N.C.

"Once physicians realize that they can use nonphysician practitioners to conduct such time-consuming facility-based tasks as admissions and discharges, they recognize the benefits of the shared-visit rule," Collins says. For instance, nonphysician practitioners can "pre-round" on patients for physicians, allowing the cardiologist to get to the root of patient problems more quickly, he says.

And here's the best part: You can still receive full Medicare reimbursement when your physicians use mid-level providers in the hospital. Moreover, by delegating such tasks as admits and discharges to nonphysician practitioners, the physician is more available to take on higher-intensity -- and higher-paying -- services such as procedures or new patient consults, Collins says.

Coding scenario: Your cardiologist is swamped with a full hospital census requiring rounding, two inpatient admissions, two patients who have been waiting three hours for discharge, one coronary intervention, and three urgent requests for consults that will go to another practice if your physician can't get to them immediately.

Without using an NPP, the cardiologist may be forced to either forfeit the consultations, which could mean the loss of about $35-$190 per initial inpatient consult depending on the complexity of the consult, or postpone the admissions, discharges and inpatient rounding, which could upset patients or allow problems to worsen. 

Winning strategy: By working with an NPP, however, the cardiologists can focus on the urgent consult requests and procedures and direct the NPP(s) to initiate the hospital admissions, discharges and to pre-round on the patients already admitted. The NPP(s) will be able to assess the patients, document admissions, document discharge summaries and make progress notes on inpatients. Following the consultations, the physician can re-evaluate the patients just visited by the NPP, document his face-to-face service with the patients, and bill for the combined service of the NPP and the physician as if the entire service had been personally performed by the physician. 

Keep in mind: To bill under the shared-visit rule, the cardiologist needs to personally evaluate the patient and document his service, Collins says. Because the NPP already interviewed the patient, conducted a preliminary examination and documented his service, the physician visit will be more focused on the problematic issues [...]