Hi there! I work at a cardiology group that currently has 12 physicians and one APRN and one PA. I was questioned by one of my physicians today on how to go about coding hospital consults and followups when the physician AND the APRN were together physically seeing each patient. How would these be coded and billed out? She was asking if there is any way that the APRN would receive a percentage from the consult? I am new to this as we just added the APRN and the PA this year. I tried looking online but couldn't find any straight answers that could help me understand this. Thank you!
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Wiki APRN and PA Hospital Billing
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Visits in the inpatient setting by both an ACP and physician are known as "split-shared" visits.
If the ACP and physician are physically both seeing the patient at the same time, the billing would be under the physician to receive maximum reimbursement.
If you are asking about how your practice measures the work done by the ACP that is not billed by the ACP, that is something your practice would need to internally decide and work through. Some practices simply don't track it at all. Others may have dummy codes not billed to insurance that they can run a report for. Others may use a spreadsheet.
If your ACPs are eligible for any type of productivity bonus, then you will want to figure out a way to track.
Just my two cents, but maybe not the best use of your ACPs time to shadow the physician all day when they could be independently seeing patients.
Here is your MAC's info about split-shared: https://med.noridianmedicare.com/we...it-or-shared-evaluation-and-management-visits
If the ACP and physician are physically both seeing the patient at the same time, the billing would be under the physician to receive maximum reimbursement.
If you are asking about how your practice measures the work done by the ACP that is not billed by the ACP, that is something your practice would need to internally decide and work through. Some practices simply don't track it at all. Others may have dummy codes not billed to insurance that they can run a report for. Others may use a spreadsheet.
If your ACPs are eligible for any type of productivity bonus, then you will want to figure out a way to track.
Just my two cents, but maybe not the best use of your ACPs time to shadow the physician all day when they could be independently seeing patients.
Here is your MAC's info about split-shared: https://med.noridianmedicare.com/we...it-or-shared-evaluation-and-management-visits
jkyles
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Picking up on what csperoni said about the NPP shadowing the physician, I would ask the physician to clarify what they mean because it really doesn't make sense to do it that way, it isn't necessary and I've never heard of anyone doing it that way. I think the physician is asking about split or shared services but perhaps they don't understand how it works?
I would add that effective Jan. 1, CMS will adopt the definition of substantive portion that is in the 2024 CPT manual. CMS and also made it clear that the provider who bills the service must document the service. That is, the physician can't just sign off on the QHP's work and get credit for the service.
Finally, please make sure everyone involved in performing or reporting these visits has a thorough understanding of the rules to avoid improper payments. This is an area that CMS is definitely keeping an eye on.
I would add that effective Jan. 1, CMS will adopt the definition of substantive portion that is in the 2024 CPT manual. CMS and also made it clear that the provider who bills the service must document the service. That is, the physician can't just sign off on the QHP's work and get credit for the service.
Finally, please make sure everyone involved in performing or reporting these visits has a thorough understanding of the rules to avoid improper payments. This is an area that CMS is definitely keeping an eye on.