Awareness : Frequently Asked Questions

Evaluation and Management (E/M) FAQs-Documentation

Documentation:

  • Question: Where are the documentation guidelines for what constitutes a face to face visit for a shared service between a physician and an NPP?

    Answer: Guidelines regarding split/shared visits can be found within the CMS Internet-only manual (IOM), Publication 100-04 Medicare Claims Processing Manual, Chapter 12, and Section 30

  • Question: Where can I find more information about evaluation and management?

    Answer: Additional information about evaluation and management can be found in the First Coast Service Option website.medicare.fcso.com

  • Question: In regard to E/M guidelines pertaining to transfer of a patient, what is meant by the term “merged records”?

    Answer: The CMS Internet-Only Manual guidelines regarding physicians billing for patient transfer are as follows:

    • Physicians may bill both the hospital discharge management code and an initial hospital care code when the discharge and admission do not occur on the same day if the transfer is between:
    • Different hospitals;
    • Different facilities under common ownership which do not have merged records; or
    • Between the acute care hospital and a Prospective Payment System (PPS) exempt unit within the same hospital when there are no merged records
    • In all other transfer circumstances, the physician should bill only the appropriate level of subsequent hospital care for the date of transfer.

    In the above summary, “merged records” would indicate the tax identification and/or the provider identification numbers being used are the same, and thus, the entity is the same. In that case, the physician should bill only the appropriate level of subsequent hospital care for the date of transfer. Source medicare.fsco.com