Question: Connecticut Subscriber Answer: Remember that if the service falls within the global period, you shouldn't charge the E/M separately. The hospital may report an E/M code sometimes. For example, the service may require so little work by the facility staff that it doesn't meet the hospital's criteria for even the lowest E/M code. Or if the patient has another procedure during the same encounter as the tube removal, then the hospital's E/M service would be included in that other procedure. So the physician and hospital E/M level do not have to match (although they may in some cases). A service that requires a great deal of physician effort may consume only minimal facility resources, or vice versa. The 2009 Outpatient Prospective Payment System (OPPS) final rule states that "While awaiting the development of a national set of facility-specific codes and guidelines, we have advised hospitals that each hospital's internal guidelines that determine the levels of clinic and emergency department visits to be reported should follow the intent of the CPT code descriptors, in that the guidelines should be designed to reasonably relate the intensity of hospital resources to the different levels of effort represented by the codes." Translation: For physicians, you choose based on whether the physician or another group physician of the same specialty has provided a face-to-face service to the patient within the last three years. Resource: