Shared/Split E&M Question

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JenniferB7
Posts: 3
Joined: Fri Jul 28, 2017 2:58 pm

Fri Jul 26, 2019 1:51 pm

I know that you cannot bill shared/split E&M for consultation codes 99241-99255. But what is everyone's take on this scenario?

A nurse practitioner sees an inpatient at the request of another provider. The nurse practitioner documents the majority of the visit and the cardiologist documents a face-to-face exam and agrees with the NP note. The visit documentation meets all shared/split E&M documentation requirements. However, the documentation is identified as a "consultation note" and meets the consultation requirements. It is simply being coded as an initial hospital visit because Medicare does not recognize consult codes.

Would you still bill this under the physician NPI since the codes being billed are not consult codes?
Thestephcode
Posts: 17
Joined: Wed May 11, 2016 8:54 pm

Mon Jul 29, 2019 9:55 am

If a provider is not billing a consult code then consultation requirements would not apply.
JenniferB7
Posts: 3
Joined: Fri Jul 28, 2017 2:58 pm

Thu Aug 08, 2019 2:27 pm

That was my thought as well, but just wanted to confirm. Thank you!
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