Urology Coding Alert

Question: We’re having some debate in our office about how to code for Medicare visits when one of our nurse practitioners “splits” a service with the urologist. Can you explain it to us so we’ll know we’re reporting things correctly?

Oregon Subscriber

Answer: A split/shared visit involves two providers and a patient; one of the providers is a physician and the other is a qualified nonphysician practitioner (NPP). During the visit, each practitioner performs a substantive portion of an evaluation and management (E/M) service for the same patient on the same date of service.

Important: You can only report split visits on E/M codes; the split visit exception doesn’t apply to procedure codes. Visits in either an office or hospital setting can qualify for split service.

Pay difference: When you bill an E/M service as split/shared, you can bill under the physician’s National Provider Identifier (NPI), which will garner the practice 100 percent reimbursement for the service. When you bill for services under a qualified NP’s NPI, you’ll only be able to wrangle 85 percent of the total reimbursement for the service.

For example, let’s say the nurse practitioner (NP) 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. Notes indicate that between the NP’s and the physician’s services, they performed a level-three consultation (99253, Inpatient consultation for a new or established patient, which requires these 3 key components: a detailed history; a detailed examination; and medical decision making of low complexity…). Depending on the specifics of the encounter, the physician might be able to report the service under her NPI.

In an office setting, a split visit might occur if the NP performs a portion of an E/M encounter, and the physician completes the E/M service (such as 99213, Office or other outpatient visit for 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: To bill a shared visit under the physician’s NPI, he must provide and document a face-to-face service for the patient. General oversight, such as reviewing the medical record, is insufficient to report under the physician’s NPI.