Forum - Questions & Answers

Oct 22nd, 2013 - lhuck

shared/split services and consultations

We still have 5 contracted commercial insurances that accept consultations. There has been confusion based on old CMS guidance as to whether we can use shared/split services guidelines on consultation codes or if CMS just states that shared/split services cannot be used on consutation because they are no longer accepted by CMS.

Is it allowable to use shared/split services with consult codes?

Oct 22nd, 2013 - nmaguire   2,606 

re: shared/split services and consultations

Not to my knowledge

Oct 23rd, 2013 - janeanderson 9 

re: shared/split services and consultations

No split/shared services cannot be utilized with consultations.

A split/shared E/M visit is defined by Medicare Part B payment policy as a medically necessary encounter with a patient where the physician and a qualified NPP each personally perform a substantive portion of an E/M visit face-to-face with the same patient on the same date of service. A substantive portion of an E/M visit involves all or some portion of the history, exam, or medical decision making key components of an E/M service. The physician and the qualified NPP must be in the same group practice or be employed by the same employer. The split/shared E/M visit applies only to selected E/M visits and settings (i.e., hospital inpatient, hospital outpatient, hospital observation, emergency department, hospital discharge, office and non facility clinic visits, and prolonged visits associated with these E/M visit codes).

The split/shared E/M policy does not apply to consultation services, critical care services, or procedures.



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