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shared visit and discharges
Part B Archive
Both CRNP & MD see pt on day of discharge. Only CRNP writes amount of time she spent on it. Can we still bill under MD as shared visit?
edited May 2017
Time based codes cannot be billed as a shared service. The time documented has to be provided and documented by the MD.
Todd Thomas, CPC, CCS-P ERcoder, Inc
President 941 NW 164th, Suite 1
firstname.lastname@example.org Edmond, OK 73013
(405) 749-2633 www.ERcoder.com
edited May 2017
While true in regards to E/M services involving residents, that is incorrect in regards to NPPs.
CMS does prohibit one E/M type—Critical Care codes—from being "shared" between a physician and NPP (billed based on the combination of physician and NPP time), but no general prohibition exists in regards to physicians and NPPs sharing other time-based E/M codes. Quite the opposite: the Claims Processing Manual specifically mentions “hospital discharge” services and “prolonged visits”—two E/M categories which are ALWAYS time-based—as examples of E/M categories that may indeed be shared by a physician and NPP.
From the Internet-only Claims Processing Manual (100-04), Chapter 12, Section 30.6.13 (H), found on p. 80 here:
The split/shared E/M visit applies only to selected E/M visits and settings (i.e., hospital inpatient, hospital outpatient, hospital observation, emergency department, hospital discharge, office and 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.
In the situation presented, as long as the MD documented a note detailing his/her performance of a “substantive portion” of the in-person part of the E/M (i.e., the substantive portion cannot be comprised of key decision-making by the MD after discussing the situation with the NPP in the hallway outside the presence of the patient), and the time documented by the NPP by-itself is enough to exceed 30 minutes, then reason dictates that the combination of their time would have of course exceeded 30 minutes, and the requirements for billing 99239 as a shared service have been met.
Seth Canterbury, CPC, CPC-I
Clinical Data Quality Education Department
University of Florida Jacksonville Physicians, Inc.
653 West Eighth Street
Tower I, Suite 606
Jacksonville, FL 32209