Pulmonology Coding Alert

You can use Medicare's shared-visit provision when your NPPs lend your pulmonologists a helping hand in the inpatient setting. For instance, an NPP can "pre-round" on patients, allowing the physician to get to the root of patient problems more quickly.

Here's the advantage: You can still receive full Medicare reimbursement when your physicians use mid-level providers in the hospital. By delegating such tasks as admits (99221-99223), hospital visits (99231-99233) and discharges (99238-99239) to NPPs, the physician is more available to take on higher-intensity -- and higher-paying -- services such as procedures (e.g., bronchoscopy, 31622-31656) or consults (99251-99255).

Shared visits in action: A pulmonologist is swamped with a full hospital census requiring rounding, two inpatient admissions, two patients who have been waiting three hours for discharge, and three urgent requests for consults that will go to another practice if your physician can't get to them immediately.

Without using an NPP, the physician may be forced to either forfeit the consultations, which could mean the loss of about $50-$210 per inpatient consult depending on the consult's complexity, or delay the admissions, discharges and inpatient rounding, which could upset patients or allow their problems to worsen.

Winning strategy: By working with an NPP, however, the pulmonologist can focus on the urgent consult requests and procedures and direct the NPP to initiate the hospital admissions and discharges and to pre-round on the patients already admitted. The NPP will be able to assess the patients, document admissions, document discharge summaries, and make progress notes on inpatients.

Following the consultations, the pulmonologist can re-evaluate the patients just visited by the NPP, document his face-to-face service with the patients, and bill for the combined service of the NPP and the physician as if the physician had personally performed the entire service.