Wiki Split/Shared

[nyyankees]

I believe I read this wrong on the Palmetto GBA website but:

The split/shared E/M visit applies only to select E/M visits and settings (i.e., hospital inpatient, hospital outpatient, hospital observation, emergency department, hospital discharge, office, non-facility clinic visits and prolonged visits associated with these E/M visit codes). The split/shared E/M policy does not apply to critical care services or procedures

I though office setting did not apply? Thanks.

 

[mitchellde]

no it applies in the office setting, for instance a NP sees a patient in followup for what would be an incident-to billed encounter. However the patient now has a new complaint, now to bill the visit under the physician the physician must also see the patient face to face. So the NP performs part of the encounter and the MD performs part documenting this with his/her own note. This is a shared encounter. You cannot share a new patient or a consult.

 

[MnTwins29]

no it applies in the office setting, for instance a NP sees a patient in followup for what would be an incident-to billed encounter. However the patient now has a new complaint, now to bill the visit under the physician the physician must also see the patient face to face. So the NP performs part of the encounter and the MD performs part documenting this with his/her own note. This is a shared encounter. You cannot share a new patient or a consult.

Debra - offhand, do you know if this is advantagous for payment purposes? Meaning the payment is better for a split service vs. billing under the NP at 85%? Thanks.

 

[mitchellde]

when it meets the criteria for shared service then billed under the MD number you get paid the MD rate so it is better reimbursement. But the MD must have a separate note showing his/her face to face portion of the encounter.

 

[MnTwins29]

when it meets the criteria for shared service then billed under the MD number you get paid the MD rate so it is better reimbursement. But the MD must have a separate note showing his/her face to face portion of the encounter.

Thank you - I did ask the question under the assumption that all criteria and documentation requirements were met (hey, a guy can dream, right??)

 

[mitchellde]

I know you did however when you teach this stuff every day, you learn to be repetitive in answers!