Wiki EM Billing for Profee and Facility Charges Together, Same NPI

[raymondcb]

I have a question about EM billing for profee and facility fees together. At my facility, the physicians charge the profee component and the facility fee under the same NPI, as there is no separate physician group. There is a question as to whether the facility fee needs a 27 modifier in addition to the 25 modifier. This would apply to our ED visits and clinic visits. Does anyone have any insight about this type of scenario? Our team is unsure if the 27 modifier is appropriate to use since these profee and facility charges are 2 components of the same visit and not truly separately identifiable visits. I'd appreciate any help, thank you!

 

[SDargaj]

You are billing them on the same claim...???

 

[Pam Warren]

Your facility fee goes out on the UB, not together with the professional charge. If they are doing work at a clinic or ED that is not their own practice (and then, they'd bill globally), know that the clinic and ED is already billing those services, so you're unbundling. Just because a provider does work at a hospital doesn't mean they bill out the hospital charge. The hospital does that. You simply indicate a different POS on your professional claim.

Maybe explain better about what your business model is and we can help?