Wiki Facility Question

[TMB1965]

Facility is an Outpatient Hospital and the Provider is billing this for a Medicare patient, and it has been denied.

99204
G0463 (for the facility charge)
94010
94010(for the facility charge)

Shouldn't it be G0463-59 with the 94010 just once?

 

[thomas7331]

Assuming the documentation supports the modifier, coding would be 99204-25 and 94010-26 for the professional claim; G0463-25 and 94010-TC for the facility claim. The TC modifier is not really necessary though if you're billing Medicare on a UB form.

 

[mitchellde]

I am not certain the physician should be billing the 94010. This is usually ordered by the provider and performed by facility staff. If you are reporting the facility and the physician charges there will be different revenue codes to indicate the facility side vs the physician side so the same code will appear twice but with different revenue codes.