Wiki E&M code by a facility

[dianechiodo]

A physician billed 99202.25. 11101, 11100 for a new patient office visit with two punch biopsies performed. We received his bill. We also received a bill from the hospital for the technical component of the pathology bill (88305) along with 99201. When questioning the hospital regarding their billing of an E&M code, I was told they are "provider based" and the charge for the 99201 is for facility-based resources (i.e. clinic costs, nurse costs); charges that go into maintaining and operating the clinic. Is this legal??? E&M coders I need your help please!

Thank you!

Diane Chiodo, CPC, CGIC

 

[Pam Warren]

It's absolutely legal and the E&M billed by the facility is not the same E&M billed by the physician. It's used to report (usually through a calculation of work done) the resources provided at the facility level..nursing care, overhead, etc. They explained it to you exactly right.

As facilities are acquiring physician employees and billing the provoder-based model, this is going to be more commonplace.

 

[dianechiodo]

Thank you, Pam, for replying to this. I continue to learn something new each day, today it is E&M coding information. I thought surely this is incorrect coding, but I stand corrected. Thanks again!

Diane Chiodo, CPC, CGIC