Wiki Billing an office visit for a patient that resides in a facility

[kfw123@sbcglobal.net]

I work for a rheumatology office. We saw a patient who resides in a psychiatric facility. She was taken out of there for just that day to be seen in our office. Is there a code that can be used for this situation?

 

[ollielooya]

I wish I could help. This is an interesting topic. We've had issues where patients from a skilled nursing facility (Part A Medicare) come to see our rheumatologist for services. In this case "Consolidated Billing" rules apply. I don't know if your situation would apply here, as we're still coming up against these rules and their directives for proper billing. I actually walked into a skilled nursing facility one day and asked to speak to their billing manager to have them explain to me how this all works. Hopefully you'll get a better more concise answer from others in the forum who have had the same experience. Will be following this topic......

 

[teresabug]

consolidated billing applies to certain patients and the determining factor is "what" they are in the facility for. For instance, patients receiving chemo or dialysis while in a facility, the facility receives that months' payment from Medicare or Medicaid for room/board/supplies and also they are paid for chemo admin. and dialysis tx. But for a psych pt, I do not see where consolidated billing would apply. You would bill an E/M new or est code with POS 11 for office.