Primary Care Coding Alert

So you have all of Medicare's rules for incident-to billing down pat. But have you ever heard of split/sharedvisit billing?

Coders that don't understand shared-visit billing could be costing their practices. Follow this advice on the basics of shared-visit billing.

During a shared visit, a qualified nonphysician practitioner (NPP) and the physician "team up" to provide a complete E/M service to the patient, confirms Lynn Anderanin, CPC, CPC-I, COSC, senior coding consultant for Health Info Services in Park Ridge, Ill. "Incident-to" billing is not applicable in the inpatient setting. However, you can bill split/shared E/M services in the hospital setting under the physician's National Provider Identifier (NPI).

The catch: The physician must provide a face-to-face service or you cannot report a shared visit in this setting, warns Kimberly Sullivan, CPC, coding specialist at Deaconess Physician Billing Services in Evansville, Ind. According to the Medicare Claims Processing Manual, Chapter 12, Section 30.6.1: "When a hospital inpatient/hospital outpatient or emergency department E/M is shared between a physician and an NPP from the same group practice and the physician provides any faceto- 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 [unique physician identification number]/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."

The Medicare manual offers this example: "If the NPP sees a hospital inpatient in the morning, and the  physician follows with a later face-to-face visit with the patient on the same day, the physician or the NPP may report the service."

Medicare payers, and payers that observe Medicare rules, allow you to report shared visits under the  physician's National Provider Identifier (NPI) rather than the NPP's. When you bill under the NPP's NPI, you'll receive 15 percent less for the same service, so ethically bill under the physician's NPI whenever you can.

Hypothetical example: A physician and NPP provide a service that qualifies for shared-visit billing, and pays out at $100. The coder's in a hurry, doesn't recognize the shared visit opportunity, and bills under the NPP's NPI. That $100 service is now only worth $85.

Clinical example: A family physician admits a patient to the hospital in the morning and sees the patient in the hospital at that time. The FP intends to check on the patient later that day, but is unable to do so because he is attending at the delivery of another patient. Consequently, an NPP sees the hospitalized patient that afternoon. In this example, it would be appropriate to bill an initial hospital care code (99221-99223) under the FP's NPI, because the FP provided a portion of the service that included a face-to-face interaction with the patient.