# G0463 documentation guidelines



## kvquill

Hello,
I am looking for documentation guidelines for code G0463. I am coding for a hospital based outpatient infusion clinic. In the HCPCS, G0463 is described as "hospital outpatient clinic visit for assessment and management of a patient". This reads to me like an E&M service. My thinking is if a patient is coming in for an infusion/transfusion/phlebotomy specifically ordered by the physician, I don't believe we can charge for a G0463 UNLESS documentation supports a separately identifiable assessment and management service. Am I reading too much into this? Any links to guidelines or specifics regarding documentation for this code would be VERY helpful!
Thank you!


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## kaa008

Yes, this is a facility E&M generated by the ancillary staff/an employee of the hospital or in my case the nurse who is employed by the facility.  The algorithm is defined by the institution since Medicare has not provided guidance like they have for the professional E&M's.  Our facility E&M's support the work of the nurse associated with an office visit where the provider is also billing an E&M.  An example of our algorithm might be: vitals - level 2, medication review by the nurse - level 2, medication update by the nurse - level 3, etc.  This is similar to the algorithm the ED had to create.

I hope this helps.


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## kvquill

Thank you for your input!
I'm a little concerned because this facility has yet to set defined parameters on facility level E&M charging. I know AHIMA and the Health Care Billing and Management Association has made recommendations regarding the consideration of visit time, frequency of monitoring, resources consumed, etc in such an algorithm, but as of now my facility does not have a set method of determination. 
Here is  a scenario:
A patient comes in for therapeutic phlebotomy.  The infusion record filled in by the nurse documents this procedure, supplies used, a time in, time out, and vitals. Is this enough documentation to support the facility coding a separate E&M level? In my mind, the reimbursement of the procedure and supplies is appropriate facility reimbursement for the staff time and resources centering around the rendering of these services?


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## only1asia04@yahoo.com

*physician's office billing specialist*

Good Afternoon, Our physician Round in multiple Hospitals and for those visits they do bill the typical E&M services (99201-99205 & 99211 & 99215)--Would the HCPCS G0463 apply to these visits for Medicare patients are is this HCPCS only being utilized by Physicians who are on staff at the Hospitals?


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## ccollison

G0463 is for facility billing, not rounding physician billing.
CCollison CPPM,CCC


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## klhoppe@mchsi.com

So, would the provider just use a 99213...…?


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## mitchellde

If your physician is making rounds in the hospital inpatient setting then you need to use the inpatient subsequent visit levels not the office visit levels.  If you provider is seeing patient in the outpatient setting at the facility then you use the office visit levels of either new or established which ever criteria the patient meets.


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