Wiki Different day DOS Physician & PA SPLIT/SHARED E/M SERVICE in Hospital

[cliff.chen89]

If both the MD & PA see the PT face to face in the hospital but on different days, can the E/M encounter be billed under the MD's name/NPI?

The only thing I can seem to find to address this is pg 38 on: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c12.pdf

where it says:

1. If the NPP sees a hospital inpatient in the morning and the physician follows with a later face-to-face visit with the patient on the same day, the physician or the NPP may report the service.

However, I can't seem to find anywhere where it explicitly addresses if the PA & MD see the PT face to face but on different days. Does anyone here know the answer?

 

[katemae84]

No, you wouldn't be able to bill the PA's services under the MD as a split/shared service. You would bill the services under whichever provider had the face-to-face with the patient for each day.

 

[cliff.chen89]

No, you wouldn't be able to bill the PA's services under the MD as a split/shared service. You would bill the services under whichever provider had the face-to-face with the patient for each day.

Thanks! If the documentation was sufficient, could we bill both the MD & PA's e/m service from both days?

 

[katemae84]

I'm not sure if you mean billing E/M services for the MD and the PA on both days, or whether you're asking if you can bill for the PA on one day & the MD on the other, as long as the documentation supports it.
If it's the first scenario, then no, you can only bill one E/M per specialty per day as a general rule. If the PA & MD both saw the patient on the same day, then you'd bill under the MD using the combined documentation from both providers to get your E/M level.
If it's the second scenario, then yes, as long their documentation supports it, then you can bill E/M services each day under which ever provider had the face-to-face visit with the patient.