Faculty Group Practice Newsletter

We continue to receive great questions from providers concerning split or shared visits for both outpatient and inpatient services. This is a complex topic. The top three questions we receive are:

Q: Does the faculty have to document their own MDM or redocument the APP’s MDM in the attestation?
A: No, faculty may claim substantive portion and therefore be the billing provider if they perform or re-perform the MDM in its entirety. Additional comments may or may not be added. The following smartphrases can assist.

Faculty smartphrases

When MDM or Time to claim substantive portion:

• .sharesplitoutptvisit or .sharesplitinptvisit
• .timespent
• .SHARESPLITCRITICALCARE (substantive portion based on time only)

Q: Can faculty claim substantive portion based on time if the APP did not document their time?
A: No, faculty may document substantive portion based on time, however, both providers' time must be documented to identify which provider has substantive portion. The coder will reach out to the APP and request they enter their time spent along with any overlapping time. The provider with more than 50% of the combined time will have substantive portion and be the billing provider. Overlapping time is credited to the faculty.

APP smartphrases

• .apptimespent
  • I spent a total of *** minutes.
• .timespent
  • The overlapping time with physician was *** minutes.

Q: When I choose the method to base substantive portion, (MDM or TIME), does the LOS have to be based on the same method?
A: No, substantive portion and level of service are two different issues. You may base your substantive portion by either method (MDM or TIME) and base the level of service by the same or different method, whichever method brings the higher level of service.

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RCO Coding Clip is a monthly feature in the FGP Newsletter, with educational and informational items for providers from our Revenue Cycle Operations Coding Team.