Question: A private physician sees a patient for a scheduled E/M visit but does not administer any treatment. He then bills Medicare for the E/M service. The doctor’s private practice office is located within the hospital, and he pays the facility nothing for the use of its space. For the hospital to receive compensation for the resources he used (such as office space and clerical staff), what revenue code should I report to Medicare?
New Hampshire Subscriber
Answer: Medicare allows you to report the technical component of evaluation and management codes, such as 99201-99215, under revenue code categories 0456 (Urgent care), 051x (Clinic), and 052x (Freestanding clinic). Other payers may offer additional options such as 0761 (Treatment room).
In this instance, since the private physician is using your facility as an extension of his office or “clinic,” 051x would be the most likely choice--as long as the documentation supports it.
