Pulmonology Coding Alert

NPP, pulmonologist can team up for certain hospital servicesIn the office setting, incident-to billing is a vital cog in the practice's reimbursement machine: Under incident-to rules, qualified nonphysician practitioners (NPPs) can treat certain patients and still bill the visit under the physician's National Provider Identifier (NPI).The hospital setting, however, is a different story. "There is no incident-to billing in the hospital," says Mary Falbo, CPC, president of Millennium Healthcare Consulting Inc. in Lansdale, Pa. "But shared/split visit billing is an option."Shared visit billing is not exactly incident-to, but it is a way to bill for services that are provided jointly by the pulmonologist and a qualified NPP. If the encounter meets shared visit guidelines, you'll be able to report the entire visit under the pulmonologist's NPI -- thereby garnering you 15 percent more pay for the same service.How? Pulmonologists receive 100 percent of the Medicare allowable when services are reported under their own NPI. If you report the same service under the NPPs NPI, the reimbursement is set at 85 percent of the Medicare allowable.'Face Time' Is a Must When Using Physician's NPIRemember that the shared visit billing rules apply to Medicare and those commercial insurers that follow Medicare rules. You shouldn't report shared visits to private insurers before making sure they allow payment for shared visits.In a nutshell: 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 pulmonologist 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."Benefit: In many shared visits, the NPP conducts the preliminary interview and exam and then the pulmonologist sees the patient. This allows the pulmonologist to focus more on the medical problem and less on the other visit components.To bill a shared visit under the physician's NPI, he must provide and document a face-to-face service for the patient. "Physicians must perform at least a portion of the E/M service that involves contact with the patient. General oversight, such as reviewing the medical record, is insufficient," according to the American College of Physicians Web site.Ideally, you'll bill a shared visit under the pulmonologist's NPI, but you could also bill a shared visit under the NPP's NPI.When? "There might be instances in which the MD's [...]