Wiki Combined NP/Physician visit?

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jacwalke

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An NP spends 20 minutes with a patient and more than 50% of the time is counseling and coordination of care, then the physician comes in and spends 25 minutes with patient with more than 50% of the time counseling and coordination of care, how would this be coded?
 
where is the patient being seen - office? is this a new or established patient? Depending on the specific circumstance, you may be able to combine all time and code based on the total time.

as a Medicare footnote, time spent by an NPP and physician in critical care cannot be combined. Per CMS Claims Processing Manual, Ch 12: "Unlike other E/M services where a split/shared service is allowed the critical care service reported shall reflect the evaluation, treatment and management of a patient by an individual physician or qualified non-physician practitioner and shall not be representative of a combined service between a physician and a qualified NPP."
 
For an established patient you can bill as a shared patient and combine the documentation and times as long the physician writes his own note of patient assessment and counseling and the time spent and referenceing the NPs note. A new patient may not be shared so the visit will be based on either the NP note and billed under his number or the physician note and billed under his number.
 
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