Otolaryngology Coding Alert

Question: Can an initial hospital visit be split/shared?


California Subscriber

Answer: You should report hospital E/M service visits based on the level of work done per day. Therefore, you should code only one visit per date of service by any given provider.

Important: When a nonphysician practitioner (NPP) and an allergist from the same group practice both provide an encounter for the same patient on the same date of service, you may combine their work to select the appropriate level of E/M service.

This type of split/shared scenario could occur during an initial admission service (99221-99223, Initial hospital care, per day, for the evaluation and management of a patient -) or a subsequent hospital visit (99231-99233, Subsequent hospital care, per day, for the evaluation and management of a patient -). Bill the correct CPT code under the physician rate of reimbursement if these encounters were:

- medically necessary 
- personally performed by each individual (both the physician and NPP provided a face-to-face service) 
- documented (each provider documented and signed his portion of the service).

In the performance of consultations (99251-99255), Medicare does not permit consultations, inpatient or outpatient, reported as split/shared services. Consultation services can only be reported in the physician's name or the NPP's name, and only the billing provider's documentation will be considered.