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Coding Mid-Level Services

Page history last edited by Kendall Rogers 8 years, 5 months ago



Compliance Alert 2/2012


Compliance Alert
Split/Shared Visits
The lease agreements between UNMH and UNMMG have been completed.
 Please refer to the information below regarding documentation for split /shared visits.

What is a split/shared visit?
By definition the term split/shared visit (Evaluation and Management Service), is used by CMS to describe an encounter where the serviced is provided partially by a non-physician provider (i.e. CNP, PA, etc.) and partially by a physician. In this circumstance, the encounter may be billed under the physician’s provider number, resulting in higher reimbursement than it if was billed by the NPP.
Guidelines for submitting a split/shared visit

The visit may be billed under the NPP or physician (not both) using the combination of their individually documented services to support the level of E/M billing.

If the physician does not see the patient face-to-face, the service cannot be billed by the physician. In these cases, the NPP may bill for his or her personally provided services.

What are the documentation requirements for split/shared visits?

The non-physician provider and the physician should each document their portion of the face-to-face encounter with the patient and each must be separately identifiable.

Examples of unacceptable documentation from the physician:

“I saw the patient with the NP and agree with findings.”

“Seen and agree.”
“I evaluated the patient. Discussed with CRNP/PA and agree with CRNP/PA's findings and plan as documented in the CRNP/PA's note. “

Counter signature only

Examples of acceptable documentation from the physician:

“I personally saw and examined patient on 1/3/2012. Discussed with CRNP and agree with CRNP’s findings and plan as documented in the CRNPs note.  Patient’s wife was present at bedside.  Patient reports that he is beginning to feel better but continues to have abdominal pain.  Examination shows abdominal tenderness. CT revealed no evidence of intestinal obstruction. Continue IV and medications.”
I personally saw and examined the patient on 1/3/2012. Key portions were reviewed and I agree with the diagnosis documented by (name of NPP), whose note is available for further detail. I examined the patient to find.....We will send the patient for a CT and will continue medication.  I agree with the diagnosis.  
Note: Please remember that you must document your face-to-face encounter with the patient which could include HPI, and exam or all or part of the medical decision making. Simply agreeing with the NPP is not acceptable.

General Points to Remember
Procedures, consultations, and critical care are NOT eligible for billing under the split/shared concept.
Must be a documented face-to-face encounter with the patient by the physician.
Policy applies to only non-physician providers (NPP), not nurses, medical students, residents, or other employees.
Physician and NPP do not have to see the patient at the same time but must see the patient on the same calendar date.

CMS Claims Processing Manual, Chapter 12, Section 30.6.1

UNMMG Guide to Documentation and Medical Coding, page 28

Questions/Concerns?   Contact: Cassandra Romero , UNMMG Interim Compliance Director / casromero@unmmg.org  /  272-0035
Distribution Date: February 3, 2012

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