Wiki HOPD -- hospital outpatient departments

[lil]

Could someone please advise how to correctly bill for HOPDs?

Currently there are two bills sent to the patient, one for the technical portion under the hospital's tin (UB-04) and a second bill for the professional portion under the provider's group tin (HCFA 1500). Is this correct? The provider's bill does list POS as being outpatient. These departments are like ASC, they are located a few miles from the hospital and all services are done at the premises.

Please help. Just not certain if this is being billed correctly since the hospital holds the license for these practices to be listed as HOPDs.

 

[mitchellde]

Yes this is correct. The hospital outpatient clinic charges an E&M for the hospital charge and the physician charges an E&M for the physician component. If a procedure is performed both entities charge the same CPT code each is paid the correct amount as long as the bill type is outpatient on the facility claim and the POS is 22 on the provider claim.

 

[lil]

Thank you for your reply, it does help to clear things up.

Another question:

If the provider charges 99213 for his service, could we also put a 99213 on the hospital's bill?

 

[mitchellde]

You put the level that is matched by the facility tool for visit levels., the physician will assign the level they have documented, and they do not need to match. Having said that, i do believe if you look,for 2014 CMS created a new code for facility outpatient visit levels. You need to check with commercial payers to see if they want the CPT E&M codes or the one HCPC code for facility visit.