SCCM Resource Library-Split/Shared Services in Critical Care

Pdf Summary

The article discusses the concept of split/shared visits for critical care in the U.S., where two healthcare practitioners, such as a physician and an advanced practice provider (APP), manage a patient encounter on the same day. In critical care, billing relies solely on the amount of time spent with the patient, as defined by CPT codes 99291 and/or 99292. When documenting and billing for these visits, practitioners sum the time they spent providing care, communicating with the patient or family, or performing necessary medical tasks. This aggregated time then determines the proper billing code.<br /><br />For a split/shared service to be billed, both physician and APP must belong to the same group, and their combined efforts should fall within the APP’s practice scope. Whether care was provided jointly or independently on the visit date, the billing can occur under either practitioner’s National Provider Identifier (NPI) number. It's important to mention that CMS reimburses split/shared services billed under a physician’s NPI at 100% of the allowed amount, while under an APP’s NPI, it's reimbursed at 85%.<br /><br />Documentation should adequately reflect the care levels provided and practitioners must appropriately document the time spent. The person spending the largest portion of time typically bills the service. APPs should be documented as practicing in the same specialty as their affiliated physicians, and specific processes and modifiers (e.g., FS) must be adhered to according to AMA and CMS guidelines.<br /><br />Case examples illustrate how time-based billing is applied practically, showcasing both physician-majority and APP-majority time billing scenarios. Lastly, it reinforces that time spent by residents alone in teaching scenarios cannot be added to a teaching physician’s billed time in critical care. This guideline helps ensure accurate and justified billing for shared services.

Asset Subtitle

Administration, 2025, 0:06:44

Asset Caption

"This article was first published in the Winter 2025 issue of Critical Connections.

A split/shared visit in the United States is a method in which two practitioners split or share the patient encounter for the date of service. In the hospital setting, split/shared visits may be determined by either medical decision-making or time. However, in critical care, since time determines the code selected, only time is used for billing critical care. The aggregated practitioners’ critical care times determine whether CPT codes 99291 and/or 99292 may be billed.

Critical Connections, the critical care industry’s only newsmagazine, provides information on cutting-edge topics in critical care useful to the entire multiprofessional team."

Meta Tag

Content Type Article

Knowledge Area Administration

Tag Staffing

Tag Healthcare Delivery

Year 2025

Keywords

split/shared visits

critical care

CPT codes

99291

99292

billing

National Provider Identifier

CMS reimbursement

advanced practice provider

time-based billing

Article

Administration

Staffing

Healthcare Delivery

2025

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