In the landscape of primary care, efficient teamwork is paramount. The concept of split or shared visits embodies this collaboration, allowing both a physician (MD/DO) and another qualified healthcare professional (QHP) to jointly provide care to a patient during a single encounter. Understanding the specific billing coding guidelines for these visits is crucial for accurate reimbursement and compliance in primary care settings.
A split or shared visit, as the term suggests, involves a physician and a QHP working together as a team. This collaborative approach during an Evaluation and Management (E/M) service means that both professionals contribute to the patient’s care on the same date of service. When determining which professional should report the service, a key factor is the “substantive portion” of the encounter. If either the physician or the QHP performs this substantive portion, they are eligible to bill for the visit.
Time plays a significant role in coding split or shared visits, especially when code selection is based on time. The total time spent by both the physician and the QHP on the date of the encounter is combined. However, it’s essential to count only “distinct time.” If there’s overlapping time, such as when both professionals are jointly meeting with the patient or discussing the case together, only the time of one individual should be counted. For time-based coding, the service is reported by the professional who spent the majority of the total face-to-face or non-face-to-face time providing the service.
It’s also important to remember what not to include in the total time. Time spent on activities that are reported separately, such as a separately billed procedure, cannot be included when selecting the E/M service level. In such cases, clear documentation is necessary. For instance, if a primary care visit includes a minor procedure like a skin tag removal, and that procedure is billed separately, the documentation should state that the time for the procedure was not included in the total visit time and was billed separately. This ensures transparency and accurate billing practices within the primary care setting.
Finally, a critical aspect of billing coding guidelines for primary care, especially concerning split or shared visits, is accurate and truthful documentation of time. Avoid using standard or template times in your documentation. Auditors often flag these as potential issues. Documenting that every Level 3 encounter lasted precisely the same amount of time, or that a fixed amount of time was always spent on EHR documentation, is not reflective of real-world patient encounters. Your documentation should genuinely reflect the actual time spent on each individual patient encounter to comply with billing coding guidelines and ensure ethical primary care practices.
