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Wiki G0463 and OV code

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Cat00a@gmail.com

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Can someone please help me understand this. I feel like this is wrong. If a visit charge has been billed why are we also submitting G0463 for the "use of clinic" w/in the hospital. This is just an office visit to the provider not an OP hospital visit charge while admitted.
 
Cat00a@gmail.com said:
Can someone please help me understand this. I feel like this is wrong. If a visit charge has been billed why are we also submitting G0463 for the "use of clinic" w/in the hospital. This is just an office visit to the provider not an OP hospital visit charge while admitted.
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For a medical office visit, reimbursement covers the physician's time and also the overhead involved in maintaining the office. When that visit occurs in a hospital owned clinic, the reimbursement is split. The physician gets paid for their time, and the clinic gets paid for the overhead.

The physician gets paid less for a visit that occurs in a facility setting, because they aren't getting paid for the overhead. You'll notice on the Medicare Physician Fee Schedule, there's a Facility Price and a Non-Facility Price for each office visit code.

Example: 99214 - Physician in a non-facility setting would be paid $129.77. However, the physician in a facility setting would only be paid $98.97.
 
sls314 said:
For a medical office visit, reimbursement covers the physician's time and also the overhead involved in maintaining the office. When that visit occurs in a hospital owned clinic, the reimbursement is split. The physician gets paid for their time, and the clinic gets paid for the overhead.

The physician gets paid less for a visit that occurs in a facility setting, because they aren't getting paid for the overhead. You'll notice on the Medicare Physician Fee Schedule, there's a Facility Price and a Non-Facility Price for each office visit code.

Example: 99214 - Physician in a non-facility setting would be paid $129.77. However, the physician in a facility setting would only be paid $98.97.
Click to expand...
What about if the patient visits different specialty doctors? would only one G0463 be billed? or multiple for the different doctors? with condition code G0 and modifier 27. I cannot find guidance if multiple visits can be charged if the facility is being used, but different doctors are being seen.
 
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