Neurology & Pain Management Coding Alert

Question: When submitting shared service claims, do you need to include extra documentation?

Nebraska Subscriber

Answer: The Medicare Claims Processing Manual Chapter 15 includes the following requirements for inpatient/ outpatient split/shared Evaluation and Management 

(E/M) services:

When a hospital inpatient/hospital outpatient (on campus-outpatient hospital or off campus outpatient hospital) 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 UPIN/PIN number. However, if 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 UPIN/PIN.

In short: The MD does not need to sign the nonphysician practitioner’s (NPP’s) note. As long as the documentation is complete, signed, legible, etc., you’re good to go. 

The physician should not, however, merely write something like “Saw the patient and agree with NPP plan.” When documenting split/shared visit coding, just as with any service, you must prove that the physician’s (and NPP’s) E/M services meet the split/shared services requirements and are medically necessary.