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Cardiology Coding Alert

Reader Questions:

Seek CMS Manual Guidance on Shared E/M

Published on Thu Aug 27, 2009

Question: Can a cardiologist and NPP share a consult and use the cardiologist's NPI? Virginia Subscriber Answer: No. Unlike most other E/Ms, "a consultation shall not be performed as a split/shared E/M visit," states the Medicare Claims Processing Manual, Chapter 12, Section 30.6.10.A (www.cms.hhs.gov/Manuals/IOM/list.asp). To report a consultation under the cardiologist's name and national provider identifier (NPI), the cardiologist must perform and document his own history of present illness (HPI), physical exam, and medical decision making (MDM). The cardiologist may consider past, family, and social histories (PFSH) and review of systems (ROS) the non-physician practitioner (NPP) documents, but the cardiologist must confirm that PFSH and ROS, according to E/M documentation guidelines (www.cms.hhs.gov/MLNEdwebGuide/25_EMDOC.asp). An NPP can perform a consult if it's within his scope of practice and meets state license requirements, but you should use the NPP's NPI in that case. Remember: Medicare may end payment for consult codes [...]
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