Wiki NP + MD Hospital Visit - Documentation requirements?

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trarut

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Hello all. I need help with understanding what needs documented and by whom in this situation. We are a community-based physician's office and are starting a new hospital rounding model using NPs to assist the physicians during rounding. One element of this model is the NP will be seeing patients we are asked to consult on and gathering history, inputting orders when needed and starting the visit note. The physician will then see the patient to perform a physical exam, discuss with the patient and develop a plan of care, amend the note started by the NP and sign off on it.

Does this sound right? This is completely new to me so I am struggling to answers questions on how to document these visits appropriately. This is not a teaching situation so I'm not convinced it's appropriate for the provider to do an addendum to the NP's note. I read somewhere that a shared visit is not appropriate for a new visit or consult but it still seems like they should each have their own note related to their portion of each visit.

Any advice is greatly appreciated.
 
Thanks for the article. When you say "what you are describing is correct for inpatient hospital", do you mean as a shared inpatient visit?
 
Sharon's article link is a great resource and breaks it all down. Basically, as long as the physician sees the patient face to face on the same date, you combine the work and bill 1 split/shared inpatient visit. You may bill under either provider, but since it's beneficial to bill under physician, that is how I would advise to bill.

You specifically question regarding a new patient or consult. 1) For new patient, I believe you are confusing with "incident to" which is for outpatient services. 2) Consults cannot be billed as split/shared. However, Medicare and most commercial carriers no longer accept consult codes. Additionally, most of the time a clinician uses the word "consult", it is not a consult by coding definitions.

Whether they should use two separate notes or an addendum, I believe either is acceptable, but this may vary based on the facility's preference or guidelines. If separate notes, it wouldn't hurt if the physician notes referenced the NP note. That way if records were requested, or an audit was being done, it would be clear from the physician note that there is additional documentation.
 
Thanks for the additional clarification, Christine. Yes, I get it about the consults. I use the term here because it is how we refer to the type of visit in the hospital. We rarely admit, we are usually requested to consult. Whether it's billable as a consult is a separate issue. I'm just trying to make sure our documentation is appropriate with both the NP & MD seeing the patient.

I appreciate the information and clarification :)
 
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