Medicare Split Visit Question


Omaha, NE
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There is some confusion of when it is appropriate to split a visit for Medicare IPPE/Initial or Subsequent AWVs utilizing the new E/M MDM if not based upon time for each (IPPE/AWV vs OV)

Can a visit be split if all other Medicare requirements are met and the patient has 2+stable chronic conditions with named prescription drug review/management?

In reviewing the Questions and Answers from CMS as follows:
Question 32 – Our physician provides a non-covered yearly exam or an initial preventive physical exam (IPPE) or annual wellness visit (AWV) at the same time as treatment for a chronic condition. How do the new changes for 2021 affect the billing?
o Answer 32 – Your documentation is crucial when performing both covered and non-covered services at the same time. To submit a charge for the IPPE or AWV, documentation will need to support those services. Documentation will need to support separate billing for treatment of a chronic condition. If billing based on time, show the total time and then the time spent specifically on the chronic condition. If billing based on MDM, documentation will have to support the level of code based on the MDM table. (added 11/17/20)
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