General Surgery Coding Alert

Question: When our surgeon splits an inpatient visit with a non-physician practitioner (NPP) for a Medicare beneficiary, how should we report the service now that we can't use the consult codes?

Florida Subscriber

Answer: You should report the encounter with the appropriate hospital care code (such as 99231-99233, Subsequent hospital care...).

You can now ignore one requirement of a shared/split inpatient visit thanks to Medicare's invalidation of the consult codes. Even if the physician does not duplicate the key components that the NPP performed, you can count all medically necessary history, examination, and medical decision making that the NPP and physician each individually perform and document on a calendar day.

Example: An NPP shares a consult with a surgeon who does not perform the key components. With the existing guideline, you could not code the service as a consult. The encounters do not meet a shared/split consult's requirement that the physician perform and document the key components.

Since there's not a consult option using the new guidelines, Medicare would allow the shared service.