Wiki Facility & Professional Coding

[mz1dynasty]

Afternoon...

Question/Help requested please. If you're able to, please provide backup with your knowledge so that I can forward.

1. When coding hospital and physician, typically the level of service is the same, correct?
2. Can facility be coded as POS 23, ER (99283) and physician coded as POS 11, office (99213) for the same encounter?

Again, any feedback is GREATLY appreciated. Thank you!

 

[Pam Warren]

1 No, the level of service does not have to be the same level, but should be from the same code section in CPT unless there's a HCPCS code that represents a more appropriate charge on the facility side. For example, a provider-based outpatient department would have G0463 for the facility charge but could have 99201-99215 for the physician's charge.
2. No. The POS must be the same for both services. So if the provider was in the ED, you'd bill Rev code 460, with the appropriate level code for the technical charge, based on the metric you use at your hospital and with 99281-99285. The physician would bill POS 23 for the emergency room and bill from the emergency room E&M codes 99281-99285 based on 3/3 key components. Hope this helps.