Wiki Time Split/Shared Visits

[lburgos31]

According to CPT 2021 Guidelines: "A shared or split visit is defined as a visit in which a physician and other qualified health care professional(s) jointly provide the face-to-face and non-face-to-face work related to the visit."

"...the time personally spent by the physician and other qualified health care professional(s) assessing and managing the patient on the date of the encounter is summed to define total time."

Question: The patient sees 2 providers from the same group (Ortho Doc & PT), the doc was seen in the morning at one location, PT was seen in the afternoon at another location BUT there are both under the same group. Do we bill 2 E/M codes respective to each specialty and split the time? Or do we combine the total time of both visits?

 

[SharonCollachi]

The claim has to have the location where the services were rendered, and since there are two different locations, you are going to have to bill them separately.

 

[lburgos31]

Ok. I understand that both claims are billed separately when they are at separate locations. What I am trying to figure out is if split/shared visits are only billed that way when 2 providers jointly provide services within the same encounter? OR In my case, when I worked for my ortho doc and we sent our patient for physical therapy, my docs claim would get denied by insurance as being inclusive because the patient saw two providers in the same company/group on the same day with the same related diagnosis. Is there is a modifier that is used to prevent that denial? OR a certain way the doc and PT should be documenting how much time was spent with that patient to be considered a shared/split visit?

 

[thomas7331]

Physical Therapists are not eligible to provide E&M services - that is not within their scope, so you cannot count the PT's time toward a physician E&M level. 'Qualified health care professionals', in the context of split/shared visits, refers only to NPs and PAs - cases where a mid-level provider and a physician in the same specialty are each performing a portion of the E&M service for the patient on the same day. The concept of a split/shared service is specific to E&M and does not apply to other diagnostic or therapeutic procedures.

The PT services would need to be billed separately. There shouldn't be a need for a modifier on the physician service and shouldn't be an issue with denials here since these are services by two different providers of different specialties - there's no overlap here.