EM Coding Alert

Question: My physician and a physician’s assistant visited the same patient in the hospital on the same day. Can I bill this as a shared service?

North Dakota Subscriber

Answer: The answer is yes if the service given by the non-physician practitioner (NPP) was just to give a helping hand to the physician in an inpatient setting by performing a portion of the E/M service, such as the history and initial examination, and the physician then also provided face-to-face service. 

Example: The service provided by the NPP was part of a pre-round for the physician. Then the physician can focus on the problem when she has her face-to-face with the patient. 

Following CMS’s shared-visit rules, you can bill claims under the physician’s NPI number as long as the physician provided face-to-face time with the patient. If no face-to-face time is provided by the physician, the service can only be billed under the NPP’s number, lowering the reimbursement.

A shared-visit claim needs to provide the following details:

• A medical record that identifies both providers.
• A connection between both providers’ encounter notes.
• Legible signatures of both providers.
• Proof that the physician provided at least one element of the encounter.

Keep in mind: The documentation must show that the physician was personally involved in some way by conducting an exam and/or planning the care of the patient.