E/M Coding Alert - 2007 Issue 7
Share the E/M Work, Enjoy Full E/M Payment
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Article Overview
This article reviews Medicare rules for shared evaluation and management services performed by physicians and nonphysician practitioners in hospital, inpatient, outpatient, emergency, and office settings. It is aimed at coders, billing staff, compliance teams, and clinicians who need to understand when a visit may be billed under a physician’s or nonphysician practitioner’s identifier, what documentation support is expected, and which service types are excluded from the shared-visit concept. The article also discusses the relationship to incident-to billing requirements and notes CMS policy references for further reading.
Why This Topic Matters
Shared-visit billing can affect how an encounter is reported and paid, so understanding the applicable Medicare framework helps reduce billing errors and support compliant documentation. The topic is especially relevant when both a physician and a nonphysician practitioner participate in the same patient encounter or when an established patient develops a new problem during office care.
Article Sections
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Physician Evaluations Are Crucial
Discusses the need for physician participation, documentation, and face-to-face involvement in shared evaluation and management services.
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Don't "Share" Consults and Critical Care, CMS Says
Reviews service categories and settings that are not treated the same as shared visits under Medicare guidance.
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Follow "Incident-to" Rules for Shared Office Visits
Summarizes the office-setting relationship between shared encounters and incident-to requirements for nonphysician practitioner services.
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New Problem Offers "Shared Visit" Opportunity
Explains how shared-visit considerations arise when an established patient develops a new problem in the office setting.
What You Will Learn
- How Medicare distinguishes shared evaluation and management services from other physician and nonphysician practitioner encounters
- What broad documentation and participation issues affect shared-visit reporting
- Which settings and service categories are discussed as exceptions to shared-visit treatment
- How shared visits relate to office-based incident-to billing concepts
- Why new-problem encounters in established patients are important in this policy area
Who Should Read This
- Medical coders
- Billing staff
- Revenue cycle professionals
- Compliance personnel
- Physicians
- Nonphysician practitioners
Codes Discussed
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