Wiki Facility Fee Office 99199

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iipm4110

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I am a physician office with a dedicated surgical suite. I have a C-Arm and CRNA. I am constantly given push back from WC and commercial payers for billing 99199(Facility Fee). BCBS stated that there is a better facility fee code to be used, does anyone know what this code is? I am not an ambulatory surgery center we are a doctor's office.

Please help I have a new coder!
 
We use 96549 for our facility fee, but we provide chemo therapy. We have the code written into our Blue Shield contract and since it is unlisted we provide an explanation in box 19. It is facility fee chemo suite. I am not sure if this would work for your office.
 
96459 is an unlisted infusion code. It is meant for actual infusion not a facilty fee. I see that you state you wrote it into the contract for that purpose but truely it cannot be interpreted this way. If you are billing with POS 11 then the "facility " fee is built into the reimbursement for the service billed. I know several have tried this but most do get denied. It is double billing in a way.
99199is unlisted special service, report or procedure. I don't think use of the physical facility comes under this definition.
 
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Debra:
I understand your response and always appreciate the input that you provide. This code is considered an unlisted chemotherapy procedure and we only utilize it with our Blue Shield claims and it is for the use of our chemotherapy suite. When I read all the information in the CPT book it includes chemotherapy administration. I am not sure how this came to be, but it has been used for several years.
 
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