Wiki ED E&M Visits

[FirstLadi]

I have a question regarding billing the professional and facility E&M services on the same day. I have a hospital that billed the CPT code 99283 with the revenue code 0405 and also the CPT code 99284 with the revenue code 0981. Neither of the procedures have a modifier applied and the place of service is 22. Is this payable and if so where is the guideline so I am able to support my view? I think that both the codes are payable because the revenue codes billed is showing that the services are for something different. Please help!!!!!

 

[mitchellde]

I think you meant revenue code 0450 which is for ER and the 0981 is for professional services. Yes the facility can bill this way, but then the physician does not submit a separate bill as the physician services are billed with the 0981 revenue code. The facility does not use POS codes though. But it would be 23 for ER. There does not need to be a modifier due to the different revenue codes. The E&M services for the facility do not need to match the physician E&M for the same service, however any procedures must match so it is possible to see the same CPT code listed twice on a facility claim when they are also billing the physician service.

 

[FirstLadi]

Thank you so very much Debra!!! I knew the facility could bill this way because I have been doing this for quite some time. Is it possible that you can give me the exact reference as to where I can locate this guideline or link to substantiate this. I have the documents stating that CMS allows the facility to bill according to theirs own system but the guideline has to still be according to CPT/E&M guidelines. I just need something in hand to support the way that the facility is billing. You have know idea how much this helps and I knew you would be the one to assist. Thank you

 

[mitchellde]

No the facility does not follow CPT E&M guidelines at all. Each facility is responsible for making their own facility guidelines. It is completely incorrect to assign a facility level using the 95 or 97 guidelines. You can find this information in the OPPS information for outpatient facility. Your facility guidelines for your facility's E&M must be in writing in your facility policies.