ED Coding and Reimbursement Alert

Get $25 more on shared 99285 claims You don't have to forfeit $25 for an NPP's role in a level-five ED E/M provided the encounter meets shared visit guidelines. There is no incident-to billing in a hospital setting, says Mary Falbo, CPC, president of Millennium Healthcare Consulting Inc. in Lansdale, Pa. "But shared/split visit billing is an option." Shared visit billing allows you to bill for services that the ED physician and a qualified nonphysician practitioner (NPP) provide jointly. If the encounter meets shared visit guidelines, you-ll be able to report the entire visit under the physician's National Provider Identifier (NPI) -- thereby garnering you 15 percent more Medicare pay for the same service than if you had to bill the service under the NP's number. -Face Time- a Must When Using MD's NPI According to Suzan Hvizdash, CPC, CPC-E/M, CPC-EDS, physician educator for the University of Pittsburgh and past member of the American Academy of Professional Coders National Advisory Board, here's how the typical shared visit works: - The NPP visits and examines a patient. The NPP documents her work establishing medical necessity. - At a different time, the physician sees the patient and documents his work. This can be immediately after or even before the NPP's visit, but it "has to be on the same day," Hvizdash says. - Then, you can add the documentation together to establish a billing level, Hvizdash said during The Coding Institute audioconference "9 Revenue-Boosting Billing Strategies for Incident-To Services." To bill a shared visit under the physician's NPI, he must provide and document a face-to-face service for the patient. "The rule of thumb is that the MD must document part of the E/M service. That can't be done without some kind of face-to-face service with the patient," says Jaime Darling, CPC, coder with EA Health Corporation in Solana Beach, Calif. Eli Berg, MD, FACEP, points out the guidance in Medicare Carrier Transmittal 1776. "When a hospital inpatient/hospital outpatient or ED E/M is shared between a physician and an NPP from the same group practice and the physician provides any face-to-face portion of the E/M encounter with the patient, the service may be billed under either the physician's or the NPP's UPIN/PIN," the transmittal states. Most Medicare carriers have further defined "face to face" as "requiring a clinically meaningful interaction with the patient in the same cubicle or partitioned/curtained area," says Berg, who is chief executive officer of Medical Reimbursement Systems Inc., an ED billing company in Woburn, Mass. Ideally, you-ll bill a shared visit under the physician's NPI, but technically you could also bill a shared visit under the NPP's NPI. Physicians receive 100 percent of the Medicare allowable when they report [...]