Orthopedic Coding Alert

Question: I’ve heard nurse practitioners (NPs) and other providers talk about “splitting” a service with a physician for Medicare patients. How can NPs and physicians “split” visits? And how would you bill for “split” visits?

Hawaii Subscriber

Answer: A split/shared visit involves two providers and a patient. During a split/shared visit, the physician and a qualified nonphysician practitioner (NPP) each perform a substantive portion of an evaluation and management (E/M) service for the same patient on the same date of service. You can only report split visits on E/M codes; the split visit exception doesn’t apply to procedure codes.

Benefit: When you bill an E/M service as split/shared, you can bill under the physician’s National Provider Identifier (NPI), which will garner the practice 100 percent reimbursement for the service. When you bill for services under a qualified NP’s NPI, you’ll only be able to wrangle 85 percent of the total reimbursement for the service.

For example, let’s say the NP sees a hospital inpatient in the morning, and the physician follows with a later face-to-face visit with the patient on the same day. Notes indicate that between the NP’s and the physician’s services, they performed a level-three consultation (99253, Inpatient consultation for a new or established patient, which requires these 3 key components: a detailed history; a detailed examination; and medical decision making of low complexity). Depending on the specifics of the encounter, the physician might be able to report the service under her NPI.

Caveat: To bill a shared visit under the physician’s NPI, he must provide and document a face-to-face service for the patient. General oversight, such as reviewing the medical record, is insufficient to report under the physician’s NPI.