2024 Gastroenterology Reimbursement and Coding Update | November 2023-11 - 2024 Split-Shared CMS Guidelines and Documentation Requirments

Pdf Summary

The document discusses the guidelines and documentation requirements for the 2024 Split-Shared Clinical Management Services (CMS). It is presented by Kristin Vaughn, a healthcare consultant and lead auditor. The webinar provides an overview for advanced practice providers (APPs) and explains who is considered an APP and their scope of practice.<br /><br />The split-shared visit is defined as a medically necessary encounter where both the physician and the Non-Physician Practitioner (NPP) each perform a substantive portion of an evaluation and management (E&M) visit on the same date of service with the same patient. The billing should be done under the practitioner who performed the substantive portion of the encounter. <br /><br />The document also discusses the guidelines for CPT Split Shared E/M Visits and how the code selection is based on total time or medical decision making. It explains that if the physician or other qualified healthcare professional (QHP) performs a substantive portion of the encounter, they can report the service. It also mentions that for code selection based on performance of a substantive part of the medical decision making, the physician or other QHP must have made or approved the management plan with the inherent risk of complications and/or morbidity or mortality.<br /><br />The document further explains the CMS Split-Shared Policy updates for 2024, including the revision of the definition of "substantive portion" to include both time and medical decision making. It also mentions that the modifier FS is required on the claim to identify a split or shared evaluation and management visit.<br /><br />The document provides examples of split-shared clinical encounters based on medical decision making and time spent by the providers.<br /><br />Overall, the document provides guidelines and documentation requirements for the 2024 Split-Shared CMS and explains how to properly bill and document split-shared visits.

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Concept Advanced Practice Provider

Concept Split/Shared Visit

Concept Substantive Portion

Concept Scope of Practice

Concept E/M Visit

Keywords

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CMS Split-Shared Policy updates

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Advanced Practice Provider

Split/Shared Visit

Substantive Portion

Scope of Practice

E/M Visit