Wiki Face To Face and E&M

[afryberger]

Hello, I know with all the changes to E&M recently, does EM still need a face to face component. I tried to research this but couldn't find my exact answer. The provider has documentation that they did not see the patient however have reviewed and agree with the providers History and assessment. They reviewed labs and CT scan and provide information to the diagnosis of the MDM. He billed 99232. They are a PA and the note they collaborated with is an MD, which did the the exam, history and portions of the MDM. I'm lost on what to do. I feel since they are of the same group, only the MD should bill but I'm not sure with all the documentation changes.

Thank you!

 

[jkyles]

Hi there,

There's been no change to the face-to-face requirement for E/M visits. For split/shared visits at least one provider must have a face-to-face encounter with the patient on the date of service. Because you mention MDM I assume you're talking about Medicare split/shared visits. In that case you'll bill under the name/NPI of the provider who performed the substantive portion of the encounter, even if that person didn't perform the face-to-face portion. In this case it looks like the physician did the substantive portion.

Remember to append modifier FS.

Here is the latest guidance from Medicare: www.cms.gov/files/document/r11828cp.pdf