Oncology & Hematology Coding Alert

Question: Is a common date of service mandatory for split visits? Do visits in outpatient and inpatient hospital settings qualify for split services? Do split services apply to procedure codes? Is there a difference in payment for billing with the physician’s NPI?

Oregon Subscriber

Answer: The split/shared visit is a Medicare concept only. For other payers (yes even Medicaid), you must check the provider manual or contract to determine if the concept is the same or how NPP services may be billed in any specific location. The split/shared visit concept involves two providers who attend to a common patient. Where one of the providers is a physician and the other is a qualified non-physician practitioner (NPP). During their respective visits, the physician and the NPP perform an evaluation and management (E/M) service for the same patient on the same date of service.

To answer your questions:

• Split/shared visits do apply to a single date of service.
• Visits in a hospital setting qualify for split/shared service. In the office, qualifying services rendered by a NPP if billed ‘incident to’ the supervising physician must follow the ‘incident to’ provision requirements and are considered to be billed as the physician’s professional service for 100% reimbursement under the Medicare physician fee schedule (PFS).
• You can only report split/shared visits with E/M codes, however thesplit/shared visit concept does not apply to critical care codes.
• The split/shared concept also does not apply to procedural services.

Hospital setting: The NP may see a hospital inpatient in the morning, and the physician may follow up with a later face-to-face visit with the patient on the same day. Notes indicate that between the NP’s and the physician’s services, they performed a level-three subsequent hospital visit (99233, Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: A detailed interval history; A detailed examination; Medical decision making of high complexity …). As long as the documentation supports, the physician would report the service under their National Provider Identifier (NPI) for 100% PFS reimbursement.

Office setting: In an outpatient hospital clinic setting, a split visit might occur if the NPP performsa portion of an E/M encounter, and the physician completes the E/M service (such as 99213, Office or other outpatient visitfor the evaluation and management of an established patient, which requires at least 2 of these 3 key components: an expanded problem focused history; an expanded problem focused examination; medical decision making of low complexity…).

Don’t miss the face-to-face service: To bill a split/shared visit under the physician’s NPI, both practitioners must provide and document a face-to-face service for the patient on that date. General oversight, such as reviewing the medical record and documenting his rationale based on the content of the note alone, is insufficient to report the E/M with the physician’s NPI.

Watch the reimbursement: When you bill an E/M service as split/shared, you can bill with the physician’s NPI. This will garner the practice 100% reimbursement for the service. When you bill for services under a qualified NP’s NPI, you will receive 85% of the total reimbursement for the service. The 15-percent increase in reimbursement requires the requirements in rendering and the documentation supports the way the visit was delivered.

Resources: Publication 100-02: Chapter 15–50.3, 60–60.4.1, 180, 190, 200, 210; Publication 100-03: Chapter 1, Part 1, Section 70.3; Publication 100-04: Chapter 12–30.6.1, 30.6.13E, 30.6.4, 120, 120.1, 130.1, 130.2 and Chapter 26–10.4.