Wiki Combining Time in a split/shared visit

[karey]

Are you able to combine face-to-face time between the patient and the NP and the patient and the Attending in a split/shared visit to determine one time based code? Example: Patient comes in to discuss treatment options for urinary incontinence. The Provider has a face-to-face discussion for 15 minutes about treatment options. The patient decides on a catheter so the provider concludes his portion of the visit and the NP comes in and spends an additional 15 minutes face-to-face with the patient giving instructions on how to use the catheter. Would you be able to bill a 99214 (25 minutes) or would you only be able to use the face-to-face time for the billing provider? Any documentation supporting your answer would be great!Thanks in advance!

 

[colsonccsp@yahoo.com]

Check out Pub 100-04 transmittal 178 change request 2321
"In the office and other outpatient setting, counseling and/or coordination of care must be provided in the presence of the patient if the time spent providing those services is used to determine the level of service reported. ***Face-to-face time refers to the time with the physician only.*** Counseling by other staff is not considered to be part of the face-to-face physician/patient encounter time. Therefore, the time spent by the other staff is not considered in selecting the appropriate level of service. The code used depends upon the physician service provided.
In an inpatient setting, the counseling and/or coordination of care must be provided at the bedside or on the patient’s hospital floor or unit that is associated with an individual patient. Time spent counseling the patient or coordinating the patient’s care after the patient has left the office or the physician has left the patient’s floor or begun to care for another patient on the floor is not considered when selecting the level of service to be reported."