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Hospitalist Billing


Best answers
Would somebody be able to advise on how to bill a midlevel hospitalist E/M done on the same day as an MD hospitalist E/M. I'm under the impression that you cannot bill the midlevel's visit at all, because basically it's double dipping. However, I'm getting some other viewpoints at work. Some people feel we should bill the midlevel and let it get adjusted off; and others feel that we should not bill the midlevel but add a level if possible onto the MD's visit if requirements are met. Does anybody have any advice?

San Diego, CA
Best answers
LeAnn is correct, if they are both of the same speciality and both personally performed part of the E/M you can bill shared visit. PER CMS
An inpatient Split/Shared Evaluation and Management (E/M) service is defined by the Centers for Medicare & Medicaid Services (CMS) IOM Publication 100-04, Chapter 12, Section 30.6.1(B), as an E/M service, "...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." Additionally, IOM Publication 100-04, Chapter 12, Section 30.6.13 (H) states that, "A split/shared E/M visit is defined by Medicare Part B payment policy as a medically necessary encounter with a patient where the physician and a qualified NPP each personally perform a substantive portion of an E/M visit face-to-face with the same patient on the same date of service. A substantive portion of an E/M visit involves all or some portion of the history, exam or medical decision making key components of an E/M service."

Leann, CPC, CEMC