This article is a continuation of our previous article on the updates announced by CMS for CY 2022 and highlights important revisions on split/shared E/M visits and critical care services.

Split (or shared) E/M visits

• Split (or shared) E/M visits will be defined as the E/M visits provided in the facility setting by a physician and an NPP in the same group.
• By 2023, the visit will be billed by the physician or practitioner who provides the substantive portion of the visit.
• For 2022, the substantive portion can be history, physical exam, medical decision-making, or more than half of the total time (except for critical care which has its own specifications).
• Split (or shared) visits can be reported for new as well as established patients, and initial and subsequent visits, as well as prolonged services and certain Skilled Nursing Facility/Nursing Facility visits.
• Documentation in the medical record must identify the two individuals who performed the visit. The individual providing the substantive portion must sign and date the medical record.
• Modifier -FS (Split or Shared E/M Visit) must be reported on claims for split (or shared) visits.

Critical Care Services

• Split or shared critical care visits: In the context of critical care, split (or shared) visits occur when the total critical care service time furnished by a physician and NPP in the same group on a given calendar date to a patient is summed, and the practitioner who furnishes the substantive portion of the cumulative critical care time reports the critical care service(s). Since, unlike other types of E/M visits, critical care services can include additional activities that are bundled into the critical care visits code(s), there is a unique listing of qualifying activities for split (or shared) critical care mentioned in CPT codebook. To bill split (or shared) critical care services, the billing practitioner first reports CPT code 99291 and, if 75 or more cumulative total minutes are spent providing critical care, the billing practitioner reports one or more units of CPT code 99292. Modifier -FS (split or shared E/M visit) must be appended to the critical care CPT code(s) on the claim.
• Critical care and other same day E/M visits: When medically necessary, critical care services can be provided at the same time to the same patient on the same day by more than 1 practitioner with more than 1 specialty as split (or shared) visits. These services will be paid if the practitioner documents that:

- The E/M visit was provided prior to the critical care service at a time when the patient didn’t require
critical care
-The visit was medically necessary
- The services are separate and distinct with no duplicative elements from the critical care service
provided later in the day.

Practitioners must report modifier -25 on the claim when reporting these critical care services.

• Critical care and global surgery: Preoperative and, or postoperative critical care may be paid in addition to a surgical procedure if the patient is critically ill (meets the definition of critical care) and requires the full attention of the physician, but the critical care should be unrelated to the surgical procedure performed, append the modifier -FT (unrelated evaluation and management (E/M) visit during a postoperative period, or on the same day as a procedure or another E/M visit)
• If care is fully transferred from the surgeon to an intensivist (and the critical care is unrelated), appropriate modifiers should be added to show the transfer of care, modifiers -54 (surgical care only) and -55 (postoperative management only) must also be reported to indicate the transfer of care. The surgeon will report modifier -54. The intensivist accepting the transfer of care will report both modifier -55 and modifier -FT. Medical record documentation must support the claims.

The Medicare claim and payment system is updated continually by the Centers for Medicare and Medicaid Services (CMS) to recognize and validate physicians’ efforts and improve quality of care, reduce health care spending by patients and participate in alternative payment models. Our aim is to provide relevant billing information and important coding updates through our articles, to our audience comprising of physicians, facilities and healthcare organizations that benefits them by swift and clean
claim submission and receive maximum reimbursement for their services.