Wiki Split/shared visit and prolonged service

[LOUISE SLACK]

Hello,

Our pediatric Oncology practice has an ARNP who will see patients the same date as the Physician. They both document their own note. The oncology patients usually reach level 5's by risk and complexity. So the physician bills 99223 (for example). Then later in the day the ARNP will see the patient, a new problem has come up. It seems there is nothing to bill for the additional work of the ARNP except prolonged service.

I have performed an exhaustive search of Medicare and MLM information to find out what documentation is ok for billing PS codes for the ARNP's visit in addition to the physicians visit. I am aware of the time threshold for billing prolonged service.

Is anyone aware of any guidance for billing prolonged services with a split/shared visit? Medicare does say the prolonged service codes are applicable to split/shared visits but no guidance is offered on how to document or code.

The split/shared E/M visit rule applies only to selected E/M visits such as these in the hospital settings:
• hospital admissions (99221-99223)
• follow-up visits (99231-99233)
• discharge management (99238-99239)
• observation care (99217-99220, 99234-99236)
• emergency department visits (99281-99285)
• prolonged care (99354-99357)
• hospital outpatient departments (provider-based visits) (99201-99215)


Thank you,
Louise

 

[mitchellde]

Unless the physician sees the patient after the NP visit and makes an attestation that the MD has also examined the patient and agrees with the documentation provided by the NP, then there is nothing that can be done. If the provider does see the patient after the NP, then both would need to document time spent as well as their note, then you would combine the notes for the 3 key components, figure out the visit level and see if total time minus the visit level time is 30 minutes or greater .