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billing based on time with PA/Physician shared visits

  1. #1
    Default billing based on time with PA/Physician shared visits
    Medical Coding Books
    According to the guidelines we have read for "shared visits" in the inpatient hospital setting - if a PA does a subsequent hospital visit for a patient and performs part of the visit and then the physician performs part of the visit - we can then bill the visit under the physician.

    Billing based on time in the hospital is not just face-to-face contact, but also floor time.

    So our question is: If you are billing based on time, and both the PA and physician see the patient, can you combine their time? (Say the PA spends 20 minutes and the physician spends 20 minutes, if you were billing based on time could you bill for 40 minutes?)
    Last edited by Colliemom; 01-14-2010 at 07:08 AM.

  2. #2
    In theory I would say yes.

    The problem I see is you still have to have the counseling/coordination piece greater than 50% to use time. So they both have to actually have face-to-face contact with the patient and document what they did in order to do the split/shared under the doctor. Then we have meet the time requirements. I would also be concerned if the documentation supported them both doing the same or very similar things then you would run into medical necessity issues.

    It would depend on the documentation as to my comfort level with this.

    Sorry probably not the easy answer you were looking for but this is what I would look for.

    Laura, CPC, CPMA, CEMC

  3. #3
    thank you, this something we are going to watch closely.

  4. #4
    Rose City (Portland, Oregon)
    I agree with Laura with one more caveat: the time cannot be concurrent. If they are both seeing the pt at the same time or looking at films or talking with the family together, the time cannot be added together. That would be double counting the same minutes. If the time is separate and over 50% is spent in C&C, you can combine and bill based upon time.


  5. #5
    that makes sense, thanks!

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