Wiki Split/Shared Billing

[PLDalsoren]

I am confused on the new split/shared billing guidelines and am hoping someone can clear up a question I have. A doctor and an NP are employed by the same practice. They see patients in an outpatient hospital clinic so billing is in POS 22 with E/M codes 99213-99215, 99203-99205. When they both see a patient and document their part, does a visit like this qualify as incident-to or split-shared? The CPT codes line up with incident-to but the place of service is split-shared. I'm sorry if this is a dumb question...maybe I'm just overthinking it.

 

[jkyles]

Hi there, it's not dumb this is very confusing.

Incident-to billing is only for visits in the office. When appropriate you can bill outpatient visits split/shared under the name/NPI of the provider who performed the "substantive portion" of the visit. The new rules are here: https://www.cms.gov/files/document/r11288cp.pdf