Shared Visit Documentation

Steve Adams, MCS, CPC, CPC-H, CPC-I

For CMS you cannot bill “incident to” in the inpatient setting under most normal circumstances. However, CMS will allow a Non Physician Provider (NPP) like a PA or NP to see a patient and use the physician’s number to bill for their services under a provision called the “shared visit.”

Because a “shared visit” in the hospital is not the same as an “incident to” service in the office, you have to document more in order to meet the criteria for the inpatient “shared visit.”

According to CMS:
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.

The important part of a shared visit is the documentation required by the MD to meet the criteria of the “shared visit.” Please make sure that as a physician sharing a visit with the NPP that you, the physician:

1.See the patient on the same day
2.Document a portion of the history, exam and decision making
3.Sign off on the note

It is not sufficient to simply document that you’ve seen and agreed with the NPP. I advise physicians to simply write a “mini” history, exam, and some decision making that shows that all three elements above have been met and that you have indeed “shared” the visit with the NPP.

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