Please Note: There is no Medicare information on our corporate website. Please select a specific contract in the 'Search Within' box for Medicare related information.
© 2019 Palmetto GBA, LLC
We frequently update our articles to reflect the latest changes and updates to Medicare, and strongly recommend you visit this article at link below to confirm you have the latest version.
Printed Date: 9/22/2015
Current reviews of medical records indicate an increasing number of Inpatient Hospital and Emergency Department services being submitted as split/shared visits between a physician and Non-Physician Practitioner (NPP) from the same group practice. The purpose of this article is to provide guidance on the appropriate documentation of split/shared services.
For a split/shared service to be reimbursed by Medicare Part B, the supporting medical records must satisfy certain documentation requirements (found in the CMS Medicare Claims Processing Manual (Pub. 100-04), chapter 12, section 30.6.1B. These requirements specify, in part:
Split/shared visits may be submitted with physician's PTAN as long as the following conditions are met:
Sufficient medical record documentation is the key to proper reimbursement. In all cases, documentation must substantiate the medical necessity of the shared/split visit; support the level of E/M code submitted, and the medical record should contain enough detail to allow a reviewer to:
Following are examples of physician documentation that would meet these criteria:
“I have personally performed a face to face diagnostic evaluation on this patient. My findings are as follows: …Patient presents with abscess, onset 3 days ago. Has tried a warm compress; hot shower for relief. Exam shows right gluteal abscess 3cm warm tender and fluctuant. Incision and drainage not indicated, started on MRSA antibiotic coverage" Signed by treating physician
“I have personally performed a face to face diagnostic evaluation on this patient. I have reviewed and agree with the care plan. History and Exam by me shows: abdomen was tender to touch, no rebound. Labs /CT scan negative. IM Toradol given for pain. Pt discharged home.” Signed by treating physician
Other important notes:
The following are a few examples of medical record documentation by the physician which would not be considered adequate to support a split/shared visit:
Medicare Claims Processing Manual (Pub. 100-04), chapter 12, section 30.6.1B (PDF, 1.13 MB)
We value your opinion and want to provide the highest-quality and most relevant Medicare knowledge possible. Please let us know if this article was helpful.
It didn't answer my question
This article was helpful
We’re glad we could help you today and appreciate your feedback. When you rate our articles as most helpful, we know that we are on the right track for providing you with important news and information.
We're sorry this article didn't help you today. We'll use your feedback to review this article to try to revise or expand it. Contact us with more feedback or a question on this topic.
Last Updated: 04/03/2018