Get
$25 more on shared 99285 claims
You
don’t have to forfeit $25 for an NPP’s role in a level-five ED
E/M provided the encounter meets shared visit guidelines.
There
is no incident-to billing in a hospital setting, says Mary
Falbo, CPC, president of Millennium Healthcare Consulting Inc. in
Lansdale,
Pa. "But shared/split visit billing is an option."
Shared
visit billing allows you to bill for services that the ED
physician and a qualified nonphysician practitioner (NPP) provide
jointly. If
the encounter meets shared visit guidelines, you’ll be able to report
the
entire visit under the physician’s National Provider Identifier (NPI)
--
thereby garnering you 15 percent more Medicare pay for the same service
than if
you had to bill the service under the NP’s number.
‘Face
Time’ a Must When Using MD’s NPI
According
to Suzan Hvizdash, CPC, CPC-E/M, CPC-EDS,
physician educator for the University of Pittsburgh and past member of
the
American Academy of Professional Coders National Advisory Board, here’s
how the typical shared visit works:
•
The NPP visits and examines a patient. The NPP documents her
work establishing medical necessity.
•
At a different time, the physician sees the patient and
documents his work. This can be immediately after or even before the
NPP’s
visit, but it "has to be on the same day," Hvizdash says.
•
Then, you can add the documentation together to establish a
billing level, Hvizdash said during The Coding Institute
audioconference
"9 Revenue-Boosting Billing Strategies for Incident-To Services."
To
bill a shared visit under the physician’s NPI, he must provide
and document a face-to-face service for the patient. "The rule of thumb
is
that the MD must document part of the E/M service. That can’t be done
without
some kind of face-to-face service with the patient," says Jaime
Darling, CPC, coder with EA Health Corporation in Solana
Beach,
Calif.
Eli
Berg, MD, FACEP, points
out the guidance in Medicare Carrier Transmittal
1776. "When a hospital inpatient/hospital outpatient or ED E/M is
shared
between a physician and an NPP from the same group practice and the
physician
provides any face-to-face portion of the E/M encounter with the
patient, the
service may be billed under either the physician’s or the NPP’s
UPIN/PIN,"
the transmittal states.
Most
Medicare carriers have further defined "face to
face" as "requiring a clinically meaningful interaction with the
patient in the same cubicle or partitioned/curtained area," says Berg,
who
is chief executive officer of Medical Reimbursement Systems Inc., an ED
billing
company in Woburn, Mass.
Ideally,
you’ll bill a shared visit under the physician’s NPI, but
technically you could also bill a shared visit under the NPP’s NPI.
Physicians
receive 100 percent of the Medicare allowable when they report services
under
their NPI. If you report the same service under the NPP’s NPI, the
reimbursement is set at 85 percent of the Medicare allowable.
"There
might be instances where the MD’s note may not include
the face-to-face encounter that is required. Maybe he only writes that
he
‘Looked at the CT scan and made recommendations,’ " Hvizdash said.
Because
the note Hvizdash described doesn’t fully illustrate the
physician’s contact with the patient, you should bill this visit under
the
NPP’s NPI. Shared billing is an option only for select hospital E/M
services,
including ED E/Ms (99281-99285); you cannot bill shared visits for
consultations
or critical care or procedures, Hvizdash said.
Caution:
Shared visit billing
rules apply to Medicare and to commercial insurers that follow Medicare
rules.
You should not report shared visits to a private insurer before making
sure it
allows payment for them.
Combine
Notes When Deciding E/M Level
Under
shared visit rules, the NPP can treat patients in the
hospital in accordance with the scope of practice and hospital
privileges
granted.
Example:
A 69-year-old male
patient reports to the ED with pain in his right lower abdominal
quadrant. An
NPP sees the patient first and orders labs and a CT scan of the
patient’s
abdomen. The NPP documents a comprehensive history and physical exam.
Due
to concern about possible appendicitis, the NPP asks the
attending physician to evaluate the patient. The ED physician evaluates
the
patient, documenting his performance of an abdominal exam and a
personal review
of the labs and CT scan. Compiled notes indicate a level-five ED E/M
service.
Under
shared visit rules, you can combine the notes when
determining the level of service for this encounter and report it under
the
physician’s NPI, Berg says.
For
this claim, you would report 99285 (Emergency department
visit for the E/M of a patient, which requires these three key
components
within the constraints imposed by the urgency of the patient’s clinical
condition and/or mental status: a comprehensive history; a
comprehensive
examination; and medical decision-making of high complexity) for
the shared
visit.
Remember
to append 789.03 (Abdominal pain; right lower quadrant)
to 99285 to represent the patient’s abdominal pain.
Benefit:
"The
bill would go out under the physician’s NPI, and the reimbursement
would be at
100 percent of the fee schedule amount," Hvizdash said.
The
99285 code reimburses about $165 at 100 percent; if you
reported 99285 under the NPP’s NPI, the amount would be about $140.
(Budget-neutral RVUs for 99285 are 4.26, multiplied by the Medicare
conversion
rate of 38.087.)
Show
Service Links in Documentation
Your
documentation must support the level of E/M service you are
coding for, or Medicare could deny your shared visit claim.
"Documentation
should offer specific details [about both
encounters] and physician input," says Alan L. Plummer, MD, at
Emory University School of Medicine in Atlanta.
When
submitting your shared service claims, be sure that you
remember to clearly identify both providers in the medical record, link
the
physician’s encounter note to the NPP’s note, and include legible
signatures
from the MD and the NPP.
Physician
Must Provide at Least 1 Element
Your
documentation must prove the physician provided at least one
element of the encounter for you to bill a shared visit under the
physician’s
NPI, Hvizdash said.
Example:
To
support physician review, in the previous example, Berg says the notes
might
read: "Patient seen and examined. Tender RLQ, WBC 12 K, will check CT
scan
and consult surgery."
|
