Shared/Split visit

There are 3 cardiologists in our practice and a nurse practitioner. In the morning, our nurse pracitiioner gets to hospital at 7 and starts with the consults. She does full history and physical, reviews labs and tests on a few patients. The doctor meets her at 8 and they discuss the patients in detail, doctor reviews labs, EKGs, and other tests, sees the patients and takes a focused H and P, then formulates a plan. The NP writes a note, doctor writes a few lines, NP dictates a full consult, the dictation is reviewed by the doctor who then signs it.

Is that billed under NP's NPI # or doctor's NPI #?

Will the reimbursement be at 85% or 100%?

I was thinking that Shared/Split visit criteria were met and that this should be billed that way - what do you think?

re: Shared/Split visit

Consultations may never be shared visits between physicians and non-physicians

re: Shared/Split visit

But consults aren't an issue any more for Medicare and split/shared is a Medicare rule.

These visits are being billed to Medicare with initial hospital services codes and may be billed as shared/split visits.

http://codapedia.com/article_356_Shared-services.cfm

re: Shared/Split visit

Did you get an answer to your question? I have the exact same question; more specifically...the NP does the History & Exam; then the physician sees the patient that same day and formulates a plan of care in the chart; the NP uses this note when she dictates the complete note which the physician reviews & signs. That handwritten note by the MD is not part of the actual note...just the dictation; so is signing the dictation enough to support that the MD did the MDM? Should the NP state that the MD saw the patient and formulated the plan in the body of the note?
Thanks!

re: Shared/Split visit

Physicians can not just sign the NP note to meet shared visit criteria. The Medicare policy (for Iowa from WPS) clearly states that both the NP and the physician must document their own notes with their own work; both must participate in the key components of the EM service. The physician note should reference the NP note, but that isn't necessarily required. The level of service supported by the combination of the two notes is billed under the physician number. If the shared visit criteria are not met, billl the NP service under his/her number.

re: Shared/Split visit

But if the MD does the MDM part of the E&M and the NP has performed the History & Exam; then it should be able to be billed as a Shared Visit. The issue in question is can the NP do the dictation using the handwritten/signed MDM note by the MD for the complete note...does this suffice stating that the MD formulated the assessment and plan for this patient. I should note that the physician always reviews the NP note and agrees w/ or adds notes to it; then signs along w/ the MDM. Does this makes sense?