what is Split or shared services , consultation services

OTHER CONSIDERATIONS SPLIT/SHARED SERVICES

A split/shared service is an encounter where a physician and a NPP each personally perform a portion of an E/M visit. Below are the rules for reporting split/shared E/M services between physicians and NPPs:

** Office/clinic setting:

• For encounters with established patients that meet incident to requirements, report the using the physician’s National Provider Identifier (NPI); and

• For encounters that do not meet incident to requirements, report using the NPP’s NPI.

** Hospital inpatient, outpatient, and ED setting encounters shared between a physician and a NPP from the same group practice:

• When the physician provides any face-to-face portion of the encounter, report using either provider’s NPI; and

• When the physician does not provide a face-to-face encounter, report using the NPP’s NPI.


CONSULTATION SERVICES

Effective for services furnished on or after January 1, 2010, inpatient consultation codes (CPT codes 99251 – 99255) and office and other outpatient consultation codes (CPT codes 99241 – 99245) are no longer recognized by Medicare for Part B payment purposes. However, telehealth consultation codes (Healthcare Common Procedure Coding System G0406 – G0408 and G0425 – G0427) continue to be recognized for Medicare payment. Physicians and NPPs who furnish services that, prior to January1, 2010, would have been reported as CPT consultation codes should report the appropriate E/M visit code in order to bill for these services beginning January 1, 2010.