How are visits performed with a nonphysician practitioner (NPP) reported?
New guidance was released in 2022 regarding shared visits, or split visits, which are defined as evaluation and management (E/M) services provided jointly between a physician and an NPP. In order for a visit to qualify as a split visit, the two practitioners must be in the same group and in the same specialty. These visits are only allowed in the facility setting (hospital) but not allowed in the nonfacility setting (office), specifically not in Place of Service (POS) 11. These visits are allowed to be reported for both new and established outpatient visits (99202–99205 and 99212–99215 respectively), initial and subsequent inpatient care, (99221–99223 and 99231–99233 respectively) and inpatient observation status care (99218-99220). The practitioner who is performing the “substantive portion” of the visit is considered the reporting or billing provider. For CY 2024, this portion will be determined based entirely on time spent on the visit; however, in the interim in CY 2022 and CY 2023, time or key components-based determination is allowed. Both face-to-face and non-face-to-face activities can be included in time calculations.
Documentation must include the names of both individual practitioners and the total time spent by each on their portion of the visit. The billing practitioner, the one conducting the substantive portion of the visit, must be the practitioner to sign and date the record. All shared E/M services must be reported with modifier -FS.
Disclaimer: SIR is providing this billing and coding guide for educational and information purposes only. It is not intended to provide legal, medical or any other kind of advice. The guide is meant to be an adjunct to the American Medical Association’s (AMA’s) Current Procedural Terminology (2022/CPT®). It is not comprehensive and does not replace CPT. Our intent is to assist physicians, business managers and coders. Therefore, a precise knowledge of the definitions of the CPT descriptors and the appropriate services associated with each code is mandatory for proper coding of physician service. Please refer to 2022 CPT® for full and complete guidelines.
Every reasonable effort has been made to ensure the accuracy of this guide; but SIR and its employees, agents, officers and directors make no representation, warranty or guarantee that the information provided is error-free or that the use of this guide will prevent differences of opinion or disputes with payers. The publication is provided “as is” without warranty of any kind, either expressed or implied, including, but not limited to, implied warranties or merchantability and fitness for a particular purpose. The company will bear no responsibility or liability for the results or consequences of the use of this manual. The ultimate responsibility for correct use of the Medicare and AMA CPT billing coding system lies with the user. SIR assumes no liability, legal, financial or otherwise for physicians or other entities who utilize the information in this guide in a manner inconsistent with the coverage and payment policies of any payers, including but not limited to Medicare or any Medicare contractors, to which the physician or other entity has submitted claims for the reimbursement of services performed by the physician.
