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  1. Luz Posted 2 month(s) agoRelated Topics

    Can a shared office visit between an NP and a physician allowed to be billed based on counseling and coordination of care; both document the time and the nature of the counseling?

  2. SuperCoder Posted 2 month(s) ago

    Hi,

    Please check the below link:

    https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/r178cp.pdf

    Hope it answers your query.

    Thanks

  3. Luz Posted 2 month(s) ago

    Thank you for the referral. I am still not sure that I am getting the answer. If we follow the incident to guidelines it cannot be billed on time. However, I read an article, and I am searching for it, and have not been able to find it that said, that if both the NP and the MD provide the service based on counseling and coordination of care, both (NP & MD) time is combined to billed based on counseling and coordination of care as incident to. Your input is appreciated.

  4. SuperCoder Posted 2 month(s) ago

    A split/shared E/M visit is defined by Medicare Part B payment policy as a medically necessary encounter with a patient where the physician and a qualified NPP each personally perform a substantive portion of an E/M visit face-to-face with the same patient on the same date of service. A substantive portion of an E/M visit involves all or some portion of the history, exam or medical decision making key components of an E/M service. The physician and the qualified NPP must be in the same group practice or be employed by the same employer. 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.

     

     

    SPLIT/SHARED SERVICES:

    A split/shared service is an encounter where a physician and a NPP each personally perform a portion of an E/M visit. Here are the rules for reporting split/shared E/M services between physicians and NPPs:

    A. In the office or clinic setting:  

    1. For encounters with established patients who meet incident to requirements, use either practitioner’s National Provider Identifier (NPI).

    2. For encounters that do not meet incident to requirements, use the NPP’s NPI.

    B. Hospital inpatient, outpatient, and ED setting encounters shared between a physician and a NPP from the same group practice:

    1. When the physician provides any face-to-face portion of the encounter, use either provider’s NPI.

    2. When the physician does not provide a face-to-face encounter, use the NPP’s NPI

     

     

     

     

    When Counseling Dominates the Visit Documentation Guidelines:

    When Counseling and/or Coordination of Care time dominates (more than 50%) of the visit, the documentation guidelines for the NPP and the physician depend on how the services are provided: Separate Visits or Overlapping Visits.

    Separate visits by the NPP and Physician where counseling dominates both visits- both the NPP and the physician need to independently document a time statement:

    Example:- NPP: “I spent 20 minutes with the patient, the majority of which was spent counseling the patient regarding _____.”

    Physician: “I spent 15 minutes with the patient, the majority of which was spent counseling the patient regarding _____.”

    Coding: The visit would be based on 35 minutes combined total time, with the majority of time (25 minutes) counseling the patient.

     

     

    Overlapping visits by the NPP and Physician where counseling dominates both visits:

    Example: The NPP sees the patient for a total time of 20 minutes, 15 minutes of which was spent counseling. The NPP then discusses the patient with the physician and both providers see the patient for a total of 15 minutes, with 10 minutes counseling time by the physician dominating the visit.

    {Important Note: Do not double count the time you work together! If the physician is going to bill, he/she will count overlapping time in his/her totals (total time and counseling time)}.

    Documentation:

    NPP: Only the NPP’s time alone with the patient can be counted towards the NPP time: 20 minutes total time and 15 minutes counseling time, both of which must be documented as well as the content of discussion. “I spent 20 minutes with the patient, 15 minutes of which was spent counseling the patient regarding _______.”

    Physician: The entire total time and entire counseling time that the physician documents will be counted. “I spent 15 minutes with the patient, 10 minutes of which was spent counseling the patient regarding _______.”

    Coding: The visit would be based on 35 minutes combined total time with 25 minutes counseling time.

  5. Luz Posted 2 month(s) ago

    Thank you so much for your respond to this question. I would like to know where in CMS I can find this guidelines, that Split Shared visit can be billed based on counseling. If not in CMS, please provide any link that you may have regarding this guidelines. Thank You

  6. SuperCoder Posted 2 month(s) ago

    Please Check the below link:

    Page no. 25 and 26. https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R2282CP.pdf

    Page no. 22 https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/eval-mgmt-serv-guide-ICN006764.pdf

  7. Luz Posted 2 month(s) ago

    Thank you for your reply and reference. I really do appreciate your help. But I do not see in the two reference that you provided(copy below)a statement indicating that both,the physician and NP are allowed to bill the shared visit based on counseling and coordination of care. If I am not understanding something on the reference I would appreciate it if you point it out to me. Thank you so much Page no. 25 and 26. https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R2282CP.pdf H. Prolonged Services Associated With Evaluation and Management Services Based on Counseling and/or Coordination of Care (Time-Based) When an evaluation and management service is dominated by counseling and/or coordination of care (the counseling and/or coordination of care represents more than 50% of the total time with the patient) in a face-to-face encounter between the physician or qualified NPP and the patient in the office/clinic or the floor time (in the scenario of an inpatient service), then the evaluation and management code is selected based on the typical/average time associated with the code levels. The time approximation must meet or exceed the specific CPT code billed (determined by the typical/average time associated with the evaluation and management code) and should not be “rounded” to the next higher level. Page no. 22 https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/eval-mgmt-serv-guide-ICN006764.pdf SPLIT/SHARED SERVICES A split/shared service is an encounter where a physician and a NPP each personally perform a portion of an E/M visit. Here are the rules for reporting split/shared E/M services between physicians and NPPs: In the office or clinic setting: For encounters with established patients who meet incident to requirements, use either practitioner’s National Provider Identifier (NPI) For encounters that do not meet incident to requirements, use the NPP’s NPI Hospital inpatient, outpatient, and ED setting encounters shared between a physician and a NPP from the same group practice: When the physician provides any face-to-face portion of the encounter, use either provider’s NPI When the physician does not provide a face-to-face encounter, use the NPP’s NPI

  8. SuperCoder Posted 2 month(s) ago

    Please check the page no.10 to 12 of below link:

    http://cecp.ucsf.edu/sites/cecp.ucsf.edu/files/wysiwyg/UCSF Split_Shared Services Final-1.pdf

    Thanks

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  • Posted by 34520 Luz, 2 month(s) ago. There are 8 posts. The latest reply is from SuperCoder.