Wiki HELP need explanation

[StacyGalloway]

Please explain to me how the Facility and the ER physician (who is not employed at the facility) can bill the same 99283 on the same DOS on the same patient.

Thank you,

Stacy, CFPC

 

[jimbo1231]

Professional vs. Technical

Basically the physican 99283 are the services provided by the physician and documented on the chart. This is the history, physical and medical decision making that the physician is responsible for. The 99283 for the technical is for hospital resources, nurse time etc used for that same patient. The 99283 for the physician services is determined usually by using the CMS 1995 guidelines; the 99283 for the hospital portion is determined using a methodology like a point system or ACEP guidelines that reasonably reflect the hospital resources utilized. The 99283 for the physician side is pretty much defined in the CPT. The 99283 on the hospital side is used because CMS/HHS determined that they wanted hospitals to use CPT codes for facility services even though the CPT book definition doesn't really apply to the facility side . and the level for physician and hospital do sometimes agree but not always. Hope that didn't confuse you more!
Another way to put it is next year the government could decide that they don't want CPT codes for the hospital ED servicesside( there have been issues with hospitals using these codes) and require some HCPC like XX123 for 99283. It is basically arbitrary on the hospital side. The the physician would continue to use 99283

 

[StacyGalloway]

Ok. I understand more about the ER billing. I bill for Family Pracitce and personally had to use the ER and was a bit confused by the CPT being used twice. I have never billed Hospital or ER so that helps.