decisionhealth Newsletters, Coder Pink Sheets - 2023 Issue 10 (October)
Split or shared facility-based E/M coding clarified in 2024 CPT manual
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Article Overview
This article covers 2024 CPT guidance for facility-based evaluation and management documentation and reporting when care is split or shared between a physician and a qualified healthcare professional. It discusses how the AMA’s guidance relates to Medicare policy, the general approach to determining the substantive portion of the visit, and the documentation considerations that apply when time or medical decision-making is used. It is intended for coders, billing staff, and clinicians who support compliant E/M reporting.
Why This Topic Matters
Accurate split or shared visit reporting affects how facility-based E/M services are documented and billed, and the article helps readers understand the updated framework in the 2024 CPT manual alongside Medicare-related considerations.
What You Will Learn
- How 2024 CPT guidance addresses shared physician and QHP involvement in facility-based E/M visits
- How substantive portion concepts are discussed in relation to time-based reporting
- How substantive portion concepts are discussed in relation to medical decision-making
- What documentation themes are emphasized when multiple professionals contribute to an encounter
- How the article frames the relationship between CPT guidance and Medicare facility policy
Who Should Read This
- Medical coders
- Billing and reimbursement staff
- Physicians
- Qualified healthcare professionals
- Practice managers
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