Pulmonology Coding Alert

Physician must see the patient if there's a new problem Judiciously using shared visits can boost your bottom line while maintaining a high level of patient care, but you have to know the requirements for reporting these services and which services are eligible for shared visits. Physician Evaluations Are Crucial A "shared visit" describes an E/M service during which a physician and a nonphysician practitioner (NPP) each see a patient for a portion of the same visit. To bill under the shared-visit rule, a physician must personally evaluate the patient and document his service. Because the NPP already interviewed the patient, conducted a preliminary examination and documented his service, the physician visit will be more focused on the medical problem. CMS guidelines dictate that when a hospital inpatient/outpatient "or emergency-department E/M is shared between a physician and an NPP from the same group practice and the physician provides any face-to-face portion of the E/M encounter with the patient, the service may be billed under either the physician's or the NPP's PIN." No face-to-face with the physician lowers reimbursement: If, however, "there was no face-to-face encounter between the patient and the physician (for instance, if the physician only reviewed the patient's medical record), you may only bill the service under the NPP's PIN, according to CMS. "Payment will be made at the appropriate Physician Fee Schedule rate based on the PIN entered on the claim."- Solidify your documentation: The key to complying with the shared-visit provision is that the physician must personally see the patient, review any history and exam performed and documented by the NPP, conduct an examination and be involved with the plan of care. This means your physician must get the documentation right. Example: The pulmonologist cannot just sign off on what the NPP writes in the progress note -- he has to contribute to the E/M. And Medicare carriers don't like to see minimal notes, such as "Agree with above" or "Rounded, reviewed, agree," so you should encourage your physicians to provide enough documentation to show that they have carefully reviewed the NPP's work. Documentation should offer specific details and physician input, says Alan L. Plummer, MD, professor of medicine, Division of Pulmonary, Allergy, and Critical Care at Emory University School of Medicine in Atlanta. To support physician review, the pulmonologist could note, "I interviewed and examined the patient. I discussed the patient's data and finding with the NPP, and I agree with the NPP's findings, assessment and plans." Don't 'Share' Consults and Critical Care Although you can use the shared-visit provision for most hospital-based E/M services, make sure you do not apply them to consultations (99251-99255, Inpatient consultation for a new or established patient ...) or [...]