Internal Medicine Coding Alert
ID Split Visits by Spotting Shared Effort
Question: The hospital admits a 78-year-old established Medicare patient suffering from chronic obstructive pulmonary disorder (COPD) and asthma as an inpatient for an acute exacerbation. The next day, a fully licensed nonphysician practitioner (NPP) performs an expanded problem-focused history and an expanded problem-focused exam to check the patient's condition. Approximately four hours later, the internist meets with the patient and performs some breathing tests and a brief pulmonary exam. Is this a shared visit? Maine Subscriber Report the following codes: • 99232 (Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: an expanded problem focused interval history; an expanded problem focused examination; medical decision making of moderate complexity ...) for the E/M 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 Benefit: When you report a shared visit, Medicare allows you to report with the physician's national provider identifier (NPI), garnering the practice 100 percent pay for 99232. If you bill the same visit under the NPP's NPI, you'll get 15 percent less for the same service.
Answer: This E/M may qualify for shared/split visit billing; be sure to satisfy Medicare's specific documentation guidelines for the claim.
• 493.22 (Chronic obstructive asthma; with [acute] exacerbation) appended to 99232 to represent the patient's COPD.
• a statement clearly identifying the NPP and MD providing 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.
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