ED Coding and Reimbursement Alert

Question: A 68-year-old Medicare patient reports to the ED with a small lump in his groin; he says he noticed it about three days ago. A fully licensed non-physician practitioner (NPP) performs an expanded problem-focused history, during which the patient reports that he had been lifting heavy boxes a week ago. The NPP also performs an expanded problem-focused exam, during which the patient reports that the mass aches slightly, but is not painful to the touch. The NPP suspects a hernia, but calls the physician in for confirmation. The physician performs a -cough test- and brief abdominal exam, confirming an inguinal hernia. The physician then puts the patient in a supportive truss, and instructs him to follow up with a surgeon for repair. Is this a shared visit?

Connecticut Subscriber

Answer: This is a split/shared visit, though there are some specific documentation guidelines you-ll need to follow for claim acceptance. Code for the claim as follows:

- 99282 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: an expanded problem focused history; an expanded problem focused examination; and medical decision making of low complexity ...) for the E/M

- 550.90 (Inguinal hernia, without mention of obstruction or gangrene, unilateral or unspecified) appended to 99282 to represent the hernia.

Documentation: The notes need to show specific details about both encounters, and include specific physician input on the patient. When reporting a shared visit, be sure to include:

- documentation of the combined notes written by the MD and the NPP that support the E/M level

- a statement clearly identifying the NPP and MDproviding the service

- a link between the physician's documentation and the NPP-s

- physician documentation of a clinically meaningful face-to-face encounter

- legible signatures from the MD and NPP providing the E/M.

Benefit: When you report a shared visit, Medicare allows you to report with the physician's national provider identifier (NPI), garnering the ED 100 percent pay for 99282. If you bill the same visit under the NPP's NPI, you-ll get 15 percent less for the same service.