Can ancillary staff be part of shared services under E/M?

I saw something that was sent out by Betsy Nicoletti, the coding intel guru there.

I love reading her stuff.

And there's a lot of things that, [chuckles] that come out that I don't ag- always agree with other consultants, but I agree probably with ninety percent of everything that, that Betsy puts out.

And I thought this was an interesting one, one that I actually get quite a bit, basically trying to bill for some ancillary staff services, especially if you are using time to level your service and, you know, are you allowed to do it.

So one of the things that is really important when it comes to physicians in independent practices, so basically you're not in a hospital system, but even if you are, the same, you know, rules apply.

But this is a lot of independent practice physicians that are trying to, you know, figure out a way to capture more revenue.

And when a physician or qualified healthcare provider, so a nurse practitioner or physician assistant, is seeing a patient and they want to use time to level their E&M service, there was a question that came up that said, "Can patients that see a nutritionist in a group practice, can you use the time spent by counseling the, um, patient? Um, and then can you sum that up by all the professionals and bill for that service?" So, you know, can you replace a nutritionist with a social worker, an athletic trainer, a pharmacist, a wellness coach? And the answer is still the same, and you can see that in not only what CPT AMA says in the E&M section but CMS's May twenty twenty-six E&M Med Learn Matters article says the same thing.

The answer is no.

So first of all, you can't have shared service in the office.

It just doesn't work for Medicare.

Now, if your other pro- other payers allow it, that's up to them, but time is not something you can share.

It says each professnal- professional, first of all, has to have E&M in the scope of their practice, but ancillary staff cannot be involved in the time.

So it talks about that the time has to be by the provider, by the physician or the QHP, has to be one provider that is using that time.

Now, in the hospital setting for shared visits, that's different.

That place of service twenty-one or twenty-two in the facility setting where you can share or split visits, that's different when it comes to, again, it still has to be a physician and qualified healthcare practitioner.

But we still see, um, some non-compliance there with ancillary staff trying to be used, and that's not okay.

Remember, you know, you have time, and then you have medical decision-making.

And sometimes when I see just these, these time, um, things that people are trying to do and, um, it just kinda makes me crazy because you're not allowed to do that.

So please stay away from that and make sure that you, you aren't including or timing a visit for that.

Now, just a side note, can nutritional, nutritionists p- bill for any services? Well, medical nutritional therapy, but they're also tied to, it's an independent service, but it's tied to specific diagnosis so, you know, renal disease, kidney disease, chronic kidney disease, um, you know, chronic diabetic patients who are insulin, um, dependent.

So it's not just for anybody who wants to s- you know, say, "Well, I have obesity.

Can I get better?" They can pay for it, absolutely, but it's not a billable service unless thir- those three, um, chronic conditions exist.

So be aware of some of the things that happen.

I was just recording with Sean Weiss on our hashtag Teri Tuesday that we do and, you know, one of our episodes from last week, we were talking about just not having policies in place for understanding what the payers say, understanding what Medicare says, also understanding what Medicaid says.

There's so much Medicaid fraud that we're now finding out out there, which doesn't really surprise me because it's so easy to do, that it's really being looked at now to make sure that you are on the up and up and you're not doing anything fraudulent.