The Rendering Provider is the person or company (laboratory or other facility) who rendered the care. In the case where a substitute provider (locum tenens) was used, enter that provider's information - A locum tenens physician takes the place of a provider when they are absent — a substitute.
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. Here are the rules for reporting split/shared E/M services between physicians and NPPs:
● In the office or clinic setting:
• For encounters with established patients who meet incident to requirements, use either practitioner’s
National Provider Identifier (NPI)
• For encounters that do not meet incident to requirements, use 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, use either provider’s NPI
• When the physician does not provide a face-to-face encounter, use the NPP’s NPI
Consultation Services
Effective for services furnished on or after January 1, 2010, Medicare no longer recognizes inpatient
consultation codes (CPT codes 99251–99255) and office and other outpatient consultation codes (CPT codes
99241–99245) for Part B payment purposes.
However, Medicare recognizes telehealth consultation codes (HCPCS G0406–G0408 and G0425–G0427)
for payment.
Physicians and NPPs who furnish services that, prior to January 1, 2010, would have been reported as CPT
consultation codes, should report the appropriate E/M visit code to bill for these services beginning
January 1, 2010.
KEY TAKEAWAYS
● While E/M services vary in several ways, such as the nature and amount of physician work required,
good general documentation principles help ensure that medical record documentation for all E/M
services is appropriate.
● When billing for a patient’s visit, select codes that best represent the services furnished during the visit.
The provider must also ensure that medical record documentation supports the level of service reported
to a payer. You should not use the volume of documentation to determine which specific level of service
to bill.
● To receive payment from Medicare for E/M services, the Medicare benefit for the relevant type of provider
must permit him or her to bill for E/M services.
● Billing Medicare for an E/M service requires the selection of a Current Procedural Terminology (CPT)
code that best represents:
• Patient type
• Setting of service
• Level of E/M service performed
