Wiki 9921X Facility?

[Jacoder]

Can we charge a 99211-99215 in the hospital setting as a facility charge? I've always thought these were physician office codes only, but upon closer observation I see where it says, "Office or other outpatient visit . . ." I've never heard of using this code in a hospital so I want to make sure this is the right thing. We will be using it for a basic wound dressing change and the patient will not be seeing a physician.

Also, can we determine which code to use solely based on time? And does the new or established criteria apply to the hospital? For instance, if this patient had labs done within the past 3 years, is he considered an established patient? Or does he have to be evaluated within the past 3 years such as an ER visit? Any help is greatly appreciated! Thanks!

 

[mitchellde]

If you are new to the outpatient facility then you need to review the APC rules and guidelines.
Yes the facility charges the same visit levels as the providers
no the providers guidelines and rules to not apply to facilty usage
the facility is required to estab;lish teir own individual set of guidelines to determine the level
no it cannot be based on time
it is based on the utilization of facility resources
The physician cannot be counted as a facility resource
Many facilities assign a point system, such as 5 points to take vital signs
A facility is allowed to charge multiple levels in the same day using a modifier 27

Hopefully this can help get you started. This has been true since August of 2000.

 

[Jacoder]

Thanks Debra!