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UCR 161: Shared split visit clarification and new rules; "Procedure to Provider" edits, PCR code denials

September 8, 2023 

Ray, Mark, and Scott discuss questions that came into the Urology Coding and Reimbursement Group:

1. We use shared visits to facilitate our inpatient consultations. Typically our APP will perform history and exam, and the physician will perform the elements of the MDM. Our coders are having a controversy as to if this is acceptable for using FS modifier stating shared visits have to be based on time and feel should be billed as the APP doing the substantive work. Our understanding is that those changes (time based only) were delayed until 2024, so for remaining 2023 the physician can continue to be the billing provider as long as we are doing the MDM element as the “substantive portion.”
   Any further clarification available?
   (Also In that scenario, would it be conceivable to be the billing provider even in the absence face to fave encounter if the elements of MDM are met. Thoughts?)
2. Does anyone know where to find "Procedure to Provider" edits? We have a PCR lab in Illinois and two of the billed codes are being denied with CO B7 reason code.  This reason code indicates the provider is not eligible for

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