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Thread: Hospital inpatient services

  1. #1
    Join Date
    Apr 2007

    Default Hospital inpatient services

    AAPC: Back to School
    I am trying to bill for a subsequent hospital visit for Dr. A in our oncology office. He saw a patient in house and is billing a subsequent hospital visit. He states in his very not so detailed note, that the Full Details are per the NP's note. Both NP and MD saw pateint on the same day. Does Dr. A have to clearly state that he reveiwed the NP's note and agrees with the management of care in order to use both notes (MD< and NP's note) for use of the documentation for the visit?

    Thank you
    Kristen Richard, CPC

  2. #2
    Join Date
    Apr 2007


    I didn't know if this could help but thought I would forward it.


    Hospital Inpatient/Outpatient/Emergency Department Setting
    When a hospital inpatient/hospital outpatient or emergency department E/M is shared between a physician and an NPP from the same group practice and the physician provides any face-to-face portion of the E/M encounter with the patient, the service may be billed under either the physician's or the NPP's UPIN/PIN number. However, if there was no face-to-face encounter between the patient and the physician (e.g., even if the physician participated in the service by only reviewing the patient’s medical record) then the service may only be billed under the NPP's UPIN/PIN. Payment will be made at the appropriate physician fee schedule rate based on the UPIN/PIN entered on the claim.
    1. If the NPP sees a hospital inpatient in the morning and the physician follows with a later face-to-face visit with the patient on the same day, the physician or the NPP may report the service.
    2. In an office setting the NPP performs a portion of an E/M encounter and the physician completes the E/M service. If the "incident to" requirements are met, the physician reports the service. If the “incident to” requirements are not met, the service must be reported using the NPP’s UPIN/PIN.
    In the rare circumstance when a physician (or NPP) provides a service that does not reflect a CPT code description, the service must be reported as an unlisted service with CPT code 99499. A description of the service provided must accompany the claim. The carrier has the discretion to value the service when the service does not meet the full terms of a CPT code description (e.g., only a history is performed). The carrier also determines the payment based on the applicable percentage of the physician fee schedule depending on whether the claim is paid at the physician rate or the non-physician practitioner rate. CPT modifier -52 (reduced services) must not be used with an evaluation and management service. Medicare does not recognize modifier -52 for this purpose.
    C. Selection Of Level Of Evaluation and Management Service Based On Duration Of Coordination Of Care and/or Counseling

  3. #3



    In a shared visit, practitioners must meet the following criteria:
    Both the NPP and physician must see the patient face-to-face on the same day and perform part of the E/M visit.
    Both must independently document their face-to-face visit with the patient.
    The visit may be billed under the NP or physician (not both) using the combination of documented services to support the level of E/M for billing.

    The key component of the shared service is the physician providing a face-to-face encounter providing all or a portion of the history, exam and MDM. I have not seen any guidelines requiring documenting the review of the NP's note like there are for teaching physicians. Did Dr. A document any history or exam and MDM?

  4. #4
    Join Date
    Apr 2007


    He did, but not much... The NP did an extensive note, so I was hoping I could use both notes to determine my E/M level...

    Thank you for your help
    Kristen Richard, CPC

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