Inpatient Facility Coding & Compliance Alert

Question: How can NPs and physicians “split” visits for Medicare patients? And how would you bill for “split” visits?

Michigan Subscriber

Answer: A split or shared visit involves two practitioners and a patient for hospital-based services (e.g., an initial hospital visit or subsequent hospital visit). During this visit, the physician and a qualified non-physician practitioner (NPP) each perform a substantive portion of an evaluation and management (E/M) service for the same patient on the same calendar date of service.

The supervision requirement for the E/M is considered “general,” meaning the physician does not need to be present when the non-physician provider sees the patient. However, the physician must see the patient face-to-face on the same calendar date, perform and document a portion of the E/M, and sign the progress notes.

Remember: You can only report split visits on E/M codes; the split visit exception doesn’t apply to procedure codes.

Benefit: When you bill an E/M service as split/shared, you can bill under the physician’s National Provider Identifier (NPI), which will garner the practice 100 percent reimbursement for the service. When you bill for services under a qualified NP’s NPI, you’ll only be able to receive 85 percent of the total reimbursement for the service.