Pulmonology Coding Alert

Question: The pulmonologist admits a 78-year-old established Medicare patient suffering from chronic obstructive pulmonary disease (COPD) as an inpatient for an acute exacerbation. The next day, a fully licensed nonphysician practitioner (NPP) performs an expanded problem focused history and an expanded problem focused exam to check the patient's condition. Approximately four hours later, the pulmonologist meets with the patient, orders pulmonary function tests, and performs a brief pulmonary exam. Is this a shared visit?

Maine Subscriber

Answer: This E/M may qualify for shared/split visit reporting if the pulmonologist and the NPP are part of the same provider group (employed by the same entity) -- but be sure to satisfy Medicare's specific documentation guidelines for the claim.

Report the following codes:

• 99232 (Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: an expanded problem focused interval history; an expanded problem focused examination; medical decision making of moderate complexity ...) for the E/M

• 491.21 (Obstructive chronic bronchitis; with [acute] exacerbation) appended to 99232 to represent the patient's COPD exacerbation.

Documentation: The notes need to show specific details about both encounters, and include specific physician input on the patient. When reporting a shared visit, be sure to include:

• documentation of the combined notes written by the MD and the NPP that support the E/M level

• a statement clearly identifying the NPP and MD providing the service

• a link between the physician's documentation and the NPP's

• documentation of a clinically meaningful face-toface encounter by each provider (NPP and physician)

• legible signatures from the MD and NPP providing the E/M.

Benefit: When you report a shared visit, Medicare allows you to report with the physician's national provider identifier (NPI), garnering the practice 100 percent pay for 99232. If you report the same visit under the NPP's NPI, you'll get a 15 percent reduction of the physician's allowable rate for the same service.