Region 4 – Shared Visits

Advanced practice practitioners (APPs) may perform and bill for Evaluation and Management (E/M)

Norma A. Panther | Region 4 – Southeast NAB Representative

encounters separately from a physician. The Medicare Claims Processing Manual further defines APPs as: nurse practitioner (NP), physician assistant (PA) clinical nurse specialist (CNS), or certified nurse midwife (CNM). For some encounters physicians may elect to split or share the encounter with an APP, each performing portions of the visit. Most E/M services may be shared by a physician and APP, critical care and procedures are the exceptions. A shared service cannot be performed in non-hospital outpatieAdvanced practice practitioners (APPs) may perform and bill for Evaluation and Management (E/M) encounters separately from a physician. The Medicare Claims Processing Manual further defines APPs as: nurse practitioner (NP), physician assistant (PA) clinical nurse specialist (CNS), or certified nurse midwife (CNM). For some encounters physicians may elect to split or share the encounter with an APP, each performing portions of the visit. Most E/M services may be shared by a physician and APP, critical care and procedures are the exceptions. A shared service cannot be performed in non-hospital outpatient clinic or office setting, this is due to the fact that “incident-to” requirements apply in this setting. This article does not address “incident-to”; instead will discuss how shared visits can be documented and billed in a hospital inpatient or outpatient, hospital observation, hospital discharge, or emergency department setting.
A shared visit has particular guidelines and documentation requirements:
• Advanced practice professional (ARNP/PA) and physician BOTH personally perform a face-to-face portion of E/M visit with the same patient on the same date,
• BOTH APP and physician perform and document the portion of history, exam and/or medical decision making they performed,
• Both are part of the same group practice, and
• APP must be an employee (or leased)

If the physician does not provide a face-to-face portion of the E/M visit and/or does not document the portion of the visit they provided, the APP should bill the
nt clinic or office setting, this is due to the fact that “incident-to” requirements apply in this setting. This article does not address “incident-to”; instead will discuss how shared visits can be documented and billed in a hospital inpatient or outpatient, hospital observation, hospital discharge, or emergency department setting.
A shared visit has particular guidelines and documentation requirements:

• Advanced practice professional (ARNP/PA) and physician BOTH personally perform a face-to-face portion of E/M visit with the same patient on the same date,
• BOTH APP and physician perform and document the portion of history, exam and/or medical decision making they performed,
• Both are part of the same group practice, and
• APP must be an employee (or leased)

If the physician does not provide a face-to-face portion of the E/M visit and/or does not document the portion of the visit they provided, the APP should bill the services.

Leave a Reply

Your email address will not be published. Required fields are marked *