Wiki Split/shared visit INPATIENT / HOSPITAL'S NP

[nayuska679]

Hoping someone can help me with this scenario. I'm trying to understand it better as I'm not familiar with this coding/billing area.

INPATIENT setting
Hospital's NP (NOT part of our private practice) (MD has privileges at hosp not employed by them)
Both NP and MD see pt on same day with both dictating their portions of the same note. (MD did exam)

Can MD bill his own services? I'm thinking no as the NP is NOT part of the same group/practice as stated by CMS guidelines.

**Copied excerpt from CMS**
Hospital Inpatient/Outpatient (On Campus or Off Campus)/Emergency
Department Setting
When a hospital inpatient/hospital outpatient (on campus-outpatient hospital or off
campus outpatient hospital) or emergency department E/M is shared between a physician
and an NPP from the same group practice and 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. Payment will be made at the appropriate physician
fee schedule rate based on the UPIN/PIN entered on the claim.

 

[thomas7331]

You're correct - the shared visit billing would only apply if both providers are in the same group - you can't use a different provider's work toward your own billing if that provider is also billing for their services and being reimbursed for them under a different entity. Your provider can only bill for their own services. He or she can use the NP's record as a source of information (i.e. as the location in the record from which he or she reviews and updates the ROS or PFSH, or as previous records reviewed toward the MDM, if documented appropriately), but the other provider's work itself cannot be claimed toward the E&M level.

 

[nayuska679]

You're correct - the shared visit billing would only apply if both providers are in the same group - you can't use a different provider's work toward your own billing if that provider is also billing for their services and being reimbursed for them under a different entity. Your provider can only bill for their own services. He or she can use the NP's record as a source of information (i.e. as the location in the record from which he or she reviews and updates the ROS or PFSH, or as previous records reviewed toward the MDM, if documented appropriately), but the other provider's work itself cannot be claimed toward the E&M level.

Thank you so much Thomas, I appreciate your response!