General Surgery Coding Alert

Physician must see the patient if there's a new problem A -shared visit- describes an E/M service during which a physician and a nonphysician practitioner (NPP) each see a patient for a portion of the same visit. Judiciously using shared visits can boost your bottom line while maintaining a high level of patient care, but you have to know the requirements for reporting these services. Physician Evaluations Are Crucial To bill under the shared-visit rule, a physician must personally evaluate the patient and document his service. Because the NPP already interviewed the patient, conducted a preliminary examination and documented his service, the physician visit will be more focused on the medical problem.

CMS guidelines dictate, -When a hospital, inpatient/hospital outpatient or emergency-department 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 PIN.-

No face-to-face with physician lowers reimbursement: If, however, -there was no face-to-face encounter between the patient and the physician (e.g., even if the physician participated in the service by only reviewing the patient's medical record), then the service may only be billed under the NPP's PIN,- according to CMS. -Payment will be made at the appropriate Physician Fee Schedule rate based on the PIN entered on the claim.- 

Solidify your documentation: The key to complying with the shared-visit provision is that the physician must personally see the patient, review any history and exam performed and documented by the NPP, conduct an examination and be involved with the plan of care. This means your physician must get the documentation right.

For instance: The doctor cannot just sign off on what the NPP writes in the progress note -- he has to contribute to the E/M. In addition, Medicare carriers don't like to see minimal notes, such as -Agree with above- or -Rounded, reviewed, agree,- so you should encourage your physicians to provide enough documentation to show that they have carefully reviewed the NPP's work.

Documentation should offer specific details and physician input, such as, -I agree with the NPP's note, except the heart murmur is louder, so I will obtain an echo to evaluate.- Don't -Share- Consults and Critical Care, CMS Says
Although you can use the shared-visit provision for most hospital-based E/M services, make sure you do not apply them to consultations (99251-99255) or critical care services (99291-99292).

-The shared-visit policy does not apply to critical care, which is a time-based service, or consultation services or [...]