Wiki ER Visit Codes

Create Wiki
The hospital bills a facility fee (9928x) and the physician charges for a professional fee (9928x). There is both a professional and facility component to all ER visits, depending on who you are coding for.
 
ER visit codes

The facility is allowed to charge for the visits as well as the physicians. The facility charges are for the room/bed, the supplies used, the instruments used, and any procedures done (this is where the TC/26 comes in), etc. The physician is also allowed to charge for seeing the patient, they use the facility (so the overhead belongs to the ER/hospital) and they will bill according to their documentation. They may not always have the same CPT code, but it's generally close because the more traumatized/sick the patient, but more supplies/instruments/parts of the facility, will be utilized.
Does this make sense? Sometimes I have trouble saying what I'm trying to get across. I lose something between my brain and my fingers.
 
Yes it does make sense but when I am looking up the fee schedules for that online it does not show that code has a professional or technical component with it.
 
The visit levels do not have a professional and technical component. This came about in 200 with APCs. Facilities had to have a way to account for the utilization of the facility resources that are consumed in a patient visit. Think of anything that cannot be accounted for with a CPT or HCPC II code. Otherwise it cannot be billed. So they made available for facility use the E&M codes. The facility uses the same codes but they mean different things to the facility. That is why you do not see professional and technical components. Also FYI the facility now has HCPC II codes to use for the ER visit levels and they still use the 992xx codes for clinic visits.
 
So when the ER is billing you for that code it is correct? It just seemed weird when I received a bill from the er physician and from the hospital and they both are charging me alot for the same code.
 
both professional and facility use 99281-99285, along with cc codes 99291-99292. One is for the physician and the other is for the facility... that is ER coding.
 
Anna Weaver said:
The facility is allowed to charge for the visits as well as the physicians. The facility charges are for the room/bed, the supplies used, the instruments used, and any procedures done (this is where the TC/26 comes in), etc. The physician is also allowed to charge for seeing the patient, they use the facility (so the overhead belongs to the ER/hospital) and they will bill according to their documentation. They may not always have the same CPT code, but it's generally close because the more traumatized/sick the patient, but more supplies/instruments/parts of the facility, will be utilized.
Does this make sense? Sometimes I have trouble saying what I'm trying to get across. I lose something between my brain and my fingers.
Click to expand...
Is the physician and the hospital both using POS 23.
 
You must log in or register to reply here.
Top