Emergency medicine coding department that do not recognize every shared visit that the physician and qualified non-physician practitioner (NPP) provide are costing their emergency department a lot of money. If you are wondering what type of encounter qualifies for shared visit, read on and figure it out for yourself:
In order to bill a visit as shared, the doctor has to carry out and document that he performed, a substantial part of the service. For instance, with an emergency department, evaluation & management service the physician needs to carry out and document that he had a clinically meaningful face to face encounter with the patient. If the doctor documents “that he was in the presence of the non-physician practitioner and agrees with his assessment, you cannot report a shared visit.
Most importantly, a shared visit must include a documented face-to-face physician service. General oversight such as reviewing the medical record is not sufficient.
What constitutes a face to face encounter has always been that the [physician] should do more than throwing back the curtain and asking if the patient is OK,'; nevertheless not to the extent of a resident /teaching physician note. The physician's comment on an element of the history, exam, decision making or course of treatment would be enough."
Medicare Transmittal 1776 also incorporates state law in terms of the degree and extent of “supervision" that's required for the non physician practitioner.
As such if you don't know what types of supervision rules your state has for doctors, be sure to check prior to coding shared visits.
States differ widely in terms of whether the supervising doctor must be 'present' or 'sign' the record, it's believed that Medicare is stating that in addition to their specific requirements that the NPP must be supervised to the level required by the state.
In order to bill a visit as shared, the doctor has to carry out and document that he performed, a substantial part of the service. For instance, with an emergency department, evaluation & management service the physician needs to carry out and document that he had a clinically meaningful face to face encounter with the patient. If the doctor documents “that he was in the presence of the non-physician practitioner and agrees with his assessment, you cannot report a shared visit.
Most importantly, a shared visit must include a documented face-to-face physician service. General oversight such as reviewing the medical record is not sufficient.
What constitutes a face to face encounter has always been that the [physician] should do more than throwing back the curtain and asking if the patient is OK,'; nevertheless not to the extent of a resident /teaching physician note. The physician's comment on an element of the history, exam, decision making or course of treatment would be enough."
Medicare Transmittal 1776 also incorporates state law in terms of the degree and extent of “supervision" that's required for the non physician practitioner.
As such if you don't know what types of supervision rules your state has for doctors, be sure to check prior to coding shared visits.
States differ widely in terms of whether the supervising doctor must be 'present' or 'sign' the record, it's believed that Medicare is stating that in addition to their specific requirements that the NPP must be supervised to the level required by the state.
