Wiki Inpatient Consult Split/Shared Services

[annvinman]

We are an orthopedic practice that routinely see consults in the hospital. Our physician assistants are on first call and see patients initially and if warranted the provider is called in to physical see the patient, this is rare. Typically the PA call the provider and discusses over the phone the history, diagnosis, labs & testing and treatment plan. Our physicians then add to the consult note the they same was reviewed and that they performed the substantiative portion of the medical decision making. Would this allow us to bill under the provider instead of the PA? I a new to this practice and historically have always billed under the provider that physically saw the patient, but wondering if we are ok to do it this way?

 

[jkyles]

Hi there, for Medicare it will depend on whether the physician's documentation shows they performed the substantive portion of the MDM, versus signing off on the PA's MDM. In the final rule CMS indicated the person who actually does (and documents) the work should report the visit.

Although we continue to believe there can be instances where MDM is not easily attributed to a single physician or NPP when the work is shared, we expect that whoever performs the MDM and subsequently bills the visit would appropriately document the MDM in the medical record to support billing of the visit.”

Betsy Nicoletti has a great, free, article here: https://codingintel.com/cms-shared-or-split-services/

I also recommend checking your MAC. It may have issued a more detailed policy based on the the 2024 updates.

 

[annvinman]

Thank you for you help.