Otolaryngology Coding Alert

Question: I know I cannot bill services incident-to in the hospital setting. Is there a way to capture the time a nonphysician practitioner (NPP) spent with a patient?

Tennessee Subscriber

Answer: Yes, you can bill split/shared E/M services in the hospital setting.

The catch: The otolaryngologist must provide a substantive portion of the service. This definition comes from the Medicare carrier First Coast: A split/shared visit is a medically necessary encounter with a patient where the physician and a qualified nonphysician practitioner (NPP) each performs a substantive portion of the E/M visit, faceto- face with the same patient on the same date of service. A substantive portion of an E/M visit involves all or some portion of the history, examination, and medical decision making components of the E/M service. Simply signing off on the NPP's note does not meet the criteria for a split/ shared visit. The physician and NPP both must be in the same group practice or employed by the same employer.

Furthermore, the split/shared visit applies only to selected E/M visits and settings and does not apply to critical care services or procedures (http://medicare.fcso.com/Wrapped/157200.asp).

When the encounter meets the criteria above, you may report the shared service under the otolaryngologist's national provider identifier (NPI) number, states Medicare Claims Processing Manual, Chapter 12, Section 30.6.1.

If there was no face-to-face encounter between the patient and the otolaryngologist (for instance, if the otolaryngologist participated only by reviewing the patient's medical record), then you would bill the service only under the NPP's NPI.

Example: On morning rounds, the NPP sees a patient who is recovering from a thyroidectomy (for instance, 60254, Thyroidectomy, total or subtotal for malignancy; with radical neck dissection). The NPP performs and documents a level two subsequent hospital visit (99232,Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components ...). Later in the day, the otolaryngologist sees and examines the patient and documents the substantive components of the face-to-face patient encounter in the medical record. In addition, the otolaryngologist reviews and documents agreement with the NPP's note.

In this example, it would be appropriate to bill a subsequent hospital care code (99232) under the otolaryngologist's NPI, because the physician provided a substantive portion of the service that included a face-to-face interaction with the patient.

Note: Check with private payers and your state Medicaid to see if they accept shared visits.