Wiki NP/MD split share services

[frankal]

If the NPP is seeing patients for subsequent visits in the hospital and is documenting their own note and the MD/DO also sees that same patient the same day, but at a different time, what does the MD/DO need to document in their note to bill under their NPI?

 

[thomas7331]

CMS states that for a split/shared service in a hospital, if "the physician provides any face-to-face portion of the E/M encounter with the patient, the service may be billed under either the physician's or the NPP's UPIN/PIN number. However, if there was no face-to-face encounter between the patient and the physician (e.g., even if the physician participated in the service by only reviewing the patient’s medical record) then the service may only be billed under the NPP's UPIN/PIN." So as I understand this the documentation must only support that the physician performed some face-to-face E&M service with the patient. I have heard of other guidelines stating that the physician must perform a 'substantial' portion of the E&M service, however I have not seen that in the Medicare manual, so that may be out of date.

 

[csperoni]

There is a fantastic AAPC article about this specific situation. https://www.aapc.com/blog/23741-medicares-splitshared-visit-policy/

Here is what that article states about what is required in the documentation to bill under the physician in the HOSPITAL setting. There are specific examples of what is and is not acceptable documentation to bill under the physician. Remember that office location requirements are different.
Acceptable Physician Documentation
Because teaching physician services involving residents is somewhat analogous to split/shared visits, these examples from the CMS material on teaching physician services (CMS Pub.100-4, Chapter 12, Section 100.1.1.A General Documentation Instruction and Common Scenarios), help establish acceptable documentation for split/shared visits:

• “I performed a history and physical examination of the patient and discussed his management with the NPP. I reviewed the NPP note and agree with the documented findings and plan of care.”
• “I saw and evaluated the patient. I reviewed the NPP’s note and agree, except that picture is more consistent with pericarditis than myocardial ischemia. Will begin NSAIDs.”
• “I saw and evaluated the patient. Agree with NPP’s note but lower extremities are weaker, now 3/5; MRI of L/S Spine today.”

Examples of unacceptable documentation by a physician:

• “Agree with above,” followed by legible countersignature or identity.
• “Rounded, Reviewed, Agree,” followed by legible countersignature or identity.
• “Discussed with NPP. Agree,” followed by legible countersignature or identity.
• “Seen and agree,” followed by legible countersignature or identity.
• “Patient seen and evaluated,” followed by legible countersignature or identity.
• A legible countersignature or identity alone.

Such documentation is not acceptable as it is not possible to determine whether the physician was present, evaluated the patient, and/or had any involvement with the plan of care.