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Shared visit with new problem

Luz Posted Mon 23rd of November, 2015 12:44:27 PM

I have a question. If I an NP saw a patient of Dr. Smith (who she previously has seen) for follow-up and a new problem was identified. Dr. Smith came in to see the patient and addressed the new problem. Both the physician and NP documented and signed their portion of the work. Can we bill as shared visit? When billing as a shared visit, can the attending physician addend the NP note or must there be a separate note? Who bills the visit? Your input is appreciated.

SuperCoder Answered Tue 24th of November, 2015 04:52:50 AM

Hi Luz,

Billing for shared visits:

In addition to understanding the requirements for incident-to billing, you should familiarize yourself with “shared visits,” a term created by the Centers for Medicare & Medicaid Services that applies only to Medicare patients. In general, incident-to services are for office-based services, and shared visits are for hospital services. Specifically, shared visits are evaluation and management (E/M) services provided to inpatients in a hospital or outpatients in the emergency department. These services are literally “shared” between physician and an NPP. If both physician and the NPP have a face-to-face encounter with the patient, the service can be billed under physician's provider number and is reimbursed at 100 percent of the physician fee schedule.

For a shared visit, physician would typically provide and document some of the E/M service and the NPP would provide and document the majority of it. This allows physician's practice to use an NPP to provide hospital services while physician return to the office to see patients. Physician do need to document this clearly to bill the service under physician's provider number.

In the hospital setting, physician must have a face-to-face encounter with the patient, documenting some part of the clinically relevant history, exam and medical decision making. It is not sufficient to simply note, “Seen and agree,” nor is it sufficient to simply countersign the note. Physician may see the patient before, after or at the same time the NPP sees the patient. The NPP will probably document the bulk of the note, but physician must specifically document what physician have personally done. Physician's practice can then select the level of service based on the combined elements and bill the encounter under physician's provider number.

Hope this will help you.

Luz Posted Tue 24th of November, 2015 09:21:55 AM

Thank you for your reply, I noticed that you reply included my name, Is this new? I do have these guidelines and If I am understanding correctly shared visits are also good for office setting. Regarding my question; the patient came for a follow up with the NP, but during the visit a new problem was addressed by the attending. Should both the NP and the attending document their work on the same note and bill under the attending provider number/name or the NP'?
Thank You,

SuperCoder Answered Wed 25th of November, 2015 02:49:14 AM

Thanks for your query,

Shared visit is only allowed in an office IF the visit meets the criteria for incident-to services. A new problem does not meet Medicare's incident-to criteria so the Supercoder staff's answer is not correct. This is addressed in Medicare's Claim Processing Manual. The following is an excerpt from Chapter 12:
In the office/clinic setting when the physician performs the E/M service the service must be reported using the physician’s UPIN/PIN. When an E/M service is a shared/split encounter between a physician and a non-physician practitioner (NP, PA, CNS or CNM), the service is considered to have been performed “incident to” if the requirements for “incident to” are met and the patient is an established patient. If “incident to” requirements are not met for the shared/split E/M service, the service must be billed under the NPP’s UPIN/PIN, and payment will be made at the appropriate physician fee schedule payment

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