Wiki Split billing tutorial

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alp.jeffrey

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Can someone give me some info on split billing? I've never billed it but I have a client I'm working now that I see a lot of it.
For instance, NP sees an inpatient consult. MD comes in and sees the patient.
So, we'll say 99222 is the level of the visit. I've seen where you are supposed to put FS. But do you bill it only under the NP?
I think I'm overthinking this but I'd love any resources and instructions on how to do this type service accurately.
 
Check your MAC, they may have good Q&As or documentation on this. Here is a Q&A from Novitas, lots of info that should help answer your questions.

In the situation you presented, yes, add FS modifier. Combine notes to determine the LOS and if both documented by time, the provider with the most time is the billing provider. If billing by MDM, it's the provider who performed the "substantive portion" of the visit. The MDM substantive portion isn't always as easy to determine so you want to be sure you understand the rules and what your organization has as their policy, like who gets credited for overlapping time when both MD and NP together discuss the patient, attestations required, etc.. In my organization, the overlapping time gets credited to the MD; if time is not documented and cannot determine who performed or no attestation as to the substantive portion, then it gets billed to whichever provider documented the note (95% of the time that is the APP so the claim is submitted as such and garners less reimbursement). Enjoy your research!
 
JDACPC said:
Check your MAC, they may have good Q&As or documentation on this. Here is a Q&A from Novitas, lots of info that should help answer your questions.

In the situation you presented, yes, add FS modifier. Combine notes to determine the LOS and if both documented by time, the provider with the most time is the billing provider. If billing by MDM, it's the provider who performed the "substantive portion" of the visit. The MDM substantive portion isn't always as easy to determine so you want to be sure you understand the rules and what your organization has as their policy, like who gets credited for overlapping time when both MD and NP together discuss the patient, attestations required, etc.. In my organization, the overlapping time gets credited to the MD; if time is not documented and cannot determine who performed or no attestation as to the substantive portion, then it gets billed to whichever provider documented the note (95% of the time that is the APP so the claim is submitted as such and garners less reimbursement). Enjoy your research!
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Thank you for this info. It's very helpful.
 
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