ACEP ID:
1. How does CPT define a Split/Shared Visit?
2. How does CMS define a Split/Shared Visit?
3. The CMS definition indicates payment is made to the physician or NPP that performs the substantive portion of the visit; how does CMS define the substantive portion?
4. What documentation is required when an ED encounter involves an ED physician and a PA/NP?
5. What documentation is necessary for the ED physician to indicate the performance of the substantive portion of a shared E/M service?
6. Does the ED physician have to document the Medical Decision Making, or can they attest to their participation in the encounter and refer to the PA/NP documentation to support reporting a Split/Shared Visit?
7. Is it necessary for the ED physician to document an attestation to confirm their participation in the encounter or performance of the substantive portion of the visit? Would documenting the MDM elements they personally completed be enough to support reporting the E&M as a shared service?
8. Can a PA/NP perform Critical Care?
9. Can Critical Care be reported as a shared service?
10. When a PA/NP performs an independent service, must the ED physician also sign the chart, or can the service be billed with only the PA/NP’s signature?
11. What is "incident to," and is it applicable in the ED?
12. Can the ED physician bill for a procedure performed by the PA/NP? Does the answer differ for Medicare versus non-Medicare patients?
13. Can the PA/NP provide services to non-Medicare patients?
14. Is the PA/NP required to have an NPI number?
15. Are special modifiers required when a PA/NP treats the patient?
16. Can a PA/NP act as a scribe for the physician?
17. To what extent, if any, will Medicare rules apply when the PA/NP treats a patient in a Medicare-managed care plan?
18. What services can a PA/NP provide in the ED?
19. Where can I get more information on Physician Assistants and Nurse Practitioners?
Updated November 2023
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The American College of Emergency Physicians (ACEP) has developed the Reimbursement & Coding FAQs and Pearls for informational purposes only. The FAQs and Pearls have been developed by sources knowledgeable in their fields, reviewed by a committee, and are intended to describe current coding practice. However, ACEP cannot guarantee that the information contained in the FAQs and Pearls is in every respect accurate, complete, or up to date.
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For information about this FAQ/Pearl, or to provide feedback, please contact Jessica Adams, ACEP Reimbursement Director, at (469) 499-0222 or jadams@acep.org.