decisionhealth Newsletters, Part B News - 2025 Issue 3 (March)
Doing the splits: MDM offers more flexibility for split/shared visits
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Article Overview
This article discusses split/shared visits in a facility setting and focuses on how medical decision-making can incorporate work performed outside the encounter date when reviewing labs, imaging, and other contributory information. It is aimed at coders, billers, and compliance staff who need to understand how CMS guidance and CPT manual principles interact for E/M services and split/shared visit documentation.
Why This Topic Matters
Split/shared visit reporting can depend on how the substantive portion of a service is determined and how prior work is documented. Understanding the relationship between CMS and CPT guidance helps coding and compliance teams evaluate whether a visit is supported by the record.
Article Sections
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Scenario and reader questions
Introduces a facility-based split/shared visit scenario and frames the two questions addressed in the article.
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Answer and supporting guidance
Summarizes the response to the reader’s questions and references the CMS and CPT guidance discussed in the article.
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Review the substantive portion rules
Explains the article’s reminder about determining the substantive portion of a visit under current E/M guidance.
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Resource
Lists the cited CMS reference used in the discussion.
What You Will Learn
- How split/shared visit questions are evaluated in a facility setting
- How CMS and CPT guidance are discussed in relation to MDM
- What kinds of documentation issues affect the substantive portion of a visit
- Why review of prior work may be relevant to E/M support
Who Should Read This
- Medical coders
- Coding auditors
- Compliance staff
- HIM professionals
- Revenue cycle staff
Code Ranges Discussed
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