Tags: rules inpatient medicare
Definition
A split/shared visit is an E/M service provided jointly by a physician and a non-physician practitioner (NPP) in the same group.
Example
If the ANP wrote the note (Name at the very top) and MD came in and wrote their attestation “I saw and evaluated hte patient”, it would be billed with ANP and MD with -FS modififer
If the MD states that they saw the patient and provided the substantive portion, then it would be billed as MD/MD with -FS modifier
2024 Medicare Changes
Substantive Portion
Starting 2024, the substantive portion determines who bills:
- More than half of total time, OR
- Most of the MDM
Requirements
| Element | Requirement |
|---|---|
| Same Group | Must be same specialty/group |
| Same Day | Services on same calendar date |
| Face-to-Face | Both must have face-to-face contact |
| Documentation | Both must document their portion |
Billing Rules
Physician Bills When
- Physician performs substantive portion
- Modifier -FS required
NPP Bills When
- NPP performs substantive portion
- No modifier required
Documentation
Split/Shared Visit Documentation:
- Provider A: 20 minutes, reviewed labs
- Provider B: 25 minutes, patient exam
- Total time: 45 minutes
- Substantive portion: Provider B
- Billing provider: Provider B
Teaching Settings
Split/shared rules do NOT apply in teaching physician settings. Different rules apply.
Not Allowed For
- Critical care services (99291-99292)
- Consultation codes
- Procedures (only E/M)
- Different specialties (generally)
Time Tracking
Each provider should document their individual time and activities for compliance.
00 Inpatient ProFee Coding MOC Teaching Physician Rules Inpatient Modifiers