2023 Gastroenterology Reimbursement and Coding Update (On-Demand) | November 2022-CMS Split-Shared CMS Guidelines

Pdf Summary

The 2022/2023 Split-Shared CMS guidelines and requirements pertain to Advanced Practice Providers (APPs) and their billing practices. APPs are independent providers with National Provider Identifiers who have a broader scope of practice than ancillary personnel. They may include Physician Assistants, Nurse Practitioners, Nurse Anesthetists, Nurse Midwives, Clinical Nurse Specialists, and Clinical Psychologists.<br /><br />A split-shared visit refers to an encounter where both a physician and an NPP perform a substantive portion of an E&M visit on the same date of service with the same patient. The visit must be billed under the practitioner who performed the substantive portion. The substantive portion can be history, physical exam, medical decision-making, or more than half of the total time.<br /><br />For split-shared E&M visits, the documentation must identify the two individuals who performed the visit. The individual providing the substantive portion must sign and date the medical record. In critical care encounters, the billing provider is determined based on who spent more than half of the total time.<br /><br />The 2023 CMS fee schedule changes propose to delay the split-shared visits policy finalized in 2022 for one year, allowing clinicians to use history, physical exam, medical decision-making, or more than half of the total practitioner time spent to define the substantive portion.<br /><br />In split-shared services, the visit can be billed under the provider who performed one of the three key components in its entirety or who spent more than half of the total visit time.<br /><br />Regarding documentation, it must identify the provider who did the substantive portion, but both providers don't have to sign the note. Percentages don't count unless substantiated by actual time spent.<br /><br />For split-shared visits in the office setting, the provider who performs and documents the visit should be the billing provider. Split shared visits are not allowed in place of service 11.<br /><br />Overall, these guidelines and requirements aim to clarify the conditions for billing split-shared visits and ensure accurate documentation and billing practices.

Asset Subtitle

Kristin Vaughn, CPC, QMC, QMGC, CPMA, ICDCT-CM

Keywords

2022/2023 Split-Shared CMS guidelines

Advanced Practice Providers

APPs

billing practices

split-shared visit

physician

NPP

E&M visit

substantive portion

CMS fee schedule changes