Happy New Year!
You may be planning on hitting the gym a little more frequently, or maybe you are hoping to lose a few pounds. Maybe 2025 is the year you will tackle that junk drawer and get organized! Jan. 1 also brings the Current Procedural Terminology ®(CPT) update.
For 2025, there are 270 new CPT codes; 112 codes have been deleted, and 38 codes have been revised.
In the months to come, we will be examining some of the changes in this update, the first being the E&M (Evaluation and Management) guidelines regarding split/shared visits. As a quick refresher, a split or shared service is an E&M visit in the facility setting that is performed in part by both a physician and a non-physician practitioner (NPP) who are both in the same group, in accordance with applicable law and regulations, such that the service could be billed by either the physician or the NPP if only one of them furnished it independently.
Additionally, the Centers for Medicare & Medicaid Services (CMS) defines a split/shared visit as one that is performed by both a physician and an NPP who bill under the same tax identification number (TIN) and are in the same specialty group.
Previous considerations have been focused on the substantive portion of the visit, and which practitioner performs it. This substantive portion can be more than half of the total time spent by the physician and NPP, or a substantive part of the medical decision-making (as defined by CPT, under the purview of the American Medical Association) for those visits involving medical decision making (MDM).
The 2025 Guideline update offers additional details and interpretation regarding the “substantive portion” of the E&M service; the first set pertains to time as the driver of the service code. The professional spending the majority of the total time on the date of the encounter would report the service for reimbursement.
The second involves the medical decision-making (MDM) as the driver of the service code. The individual who approves the care plan for the problems addressed and takes responsibility related to management of risk is the person providing the substantive portion of the visit, under these criteria. If date is used to assign the level of MDM, only the person who performs an independent interpretation or discussion of management or test interpretation may use those categories.
It is interesting to note that no modifiers are specified here. Previously, these split/shared visits were reported with the FS modifier. Remember, these updates took effect as of Jan. 1, 2025. Be sure to review the update in its entirely and share the changes with your providers and team.
Here’s hoping you have a happy, healthy 2025!
Programming note:
Listen to Christine Geiger today when she joins the live edition of Talk Ten Tuesday and reports on the latest coding news.
Combat is often described as hours of boredom intermixed with moments of sheer terror. I fear that that metaphor is increasingly applicable to Medicare enrollment. Few
Let’s start with a recent (U.S. Department of Health and Human Services Office of Inspector General) OIG audit of a Medicare Advantage plan. Now these
Please log in to your account to comment on this article.
Uncover essential coding insights with nationally recognized coding authority Kay Piper, RHIA, CDIP, CCS. Through ICD10monitor’s interactive, on‑demand webcast series, Kay walks you through the AHA’s 2026 ICD‑10‑CM/PCS Quarterly Coding Clinics, translating each update into practical, easy‑to‑apply guidance designed to sharpen precision, ensure compliance, and strengthen day‑to‑day decision‑making. Available shortly after each official release.
Uncover critical guidance on the ICD-10-CM/PCS code updates. Kay Piper reviews and explains ICD-10-CM/PCS coding guidelines in the AHA’s fourth quarter 2026 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
Uncover critical guidance on the ICD-10-CM/PCS code updates. Kay Piper reviews and explains ICD-10-CM/PCS coding guidelines in the AHA’s third quarter 2026 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
Uncover critical guidance on the ICD-10-CM/PCS code updates. Kay Piper reviews and explains ICD-10-CM/PCS coding guidelines in the AHA’s second quarter 2026 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
Federal auditors are intensifying their focus on inpatient psychiatric facilities, using advanced data analytics to spotlight outliers and pursue high‑dollar repayments. In this high‑impact webcast, Michael Calahan, PA, MBA, Compliance Officer and V.P., Hospital & Physician Compliance, breaks down what regulators are really targeting in IPF-PPS admissions, documentation, treatment and discharge planning. Attendees will learn practical steps to tighten processes, avoid common audit triggers and protect reimbursement and reduce the risk of multimillion-dollar repayment demands.
In this timely session, Stacey Shillito, CDIP, CPMA, CCS, CCS-P, CPEDC, COPC, breaks down the complexities of Medical Decision Making (MDM) documentation so providers can confidently capture the true complexity of their care. Attendees will learn practical, efficient strategies to ensure documentation aligns with current E/M guidelines, supports accurate coding, and reduces audit risk, all without adding to charting time.
Join Ronald Hirsch, MD, FACP, CHCQM for The PEPPER Returns – Risk and Opportunity at Your Fingertips, a practical webcast that demystifies the PEPPER and shows you how to turn complex claims data into actionable insights. Dr. Hirsch will explain how to interpret key measures, identify compliance risks, uncover missed revenue opportunities, and understand new updates in the PEPPER, all to help your organization stay ahead of audits and use this powerful data proactively.
Stay ahead of the 2026-2027 audit surge with “Top 10 Audit Targets for 2026-2027 for Hospitals & Physicians: Protect Your Revenue,” a high-impact webcast led by Michael Calahan, PA, MBA. This concise session gives hospitals and physicians clear insight into the most likely federal audit targets, such as E/M services, split/shared and critical care, observation and admissions, device credits, and Two-Midnight Rule changes, and shows how to tighten documentation, coding, and internal processes to reduce denials, recoupments, and penalties. Attendees walk away with practical best practices to protect revenue, strengthen compliance, and better prepare their teams for inevitable audits.
Prepare for the 2025 CMS IPPS Final Rule with ICD10monitor’s IPPSPalooza! Click HERE to learn more
Get 15% OFF on all educational webcasts at ICD10monitor with code JULYFOURTH24 until July 4, 2024—start learning today!
BLOOM INTO SAVINGS! Get 25% OFF during our spring sale through March 27. Use code SPRING26 at checkout to claim this offer.
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 1 with code CYBER25
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
