Primary Care Coding Alert

When your clinician and your NPP perform parts of an E/M service for a patient, you will need to identify and check if you can report the services performed by both as split/shared E/M or as an incident-to visit.

A split/shared E/M visit is defined to as “a medically necessary encounter with a patient where the physician and a qualified MLP each personally perform a substantive portion of an E/M visit face-to-face with the same patient on the same date of service,” according to the Centers for Medicare & Medicaid Services (CMS) claims processing manual. “A split/shared E/M service is one in which both the NPP and the physician contribute to the provision of the service,” says Kent Moore, senior strategist for physician payment at the American Academy of Family Physicians.

On the other hand, incident-to services are defined by CMS as “services or supplies furnished as an integral, although incidental, part of the physician’s personal professional services in the course of diagnosis or treatment of an injury or illness.”