gdicrocco
New
Is it appropriate to bill a facility E/M (99211) on every visit in a wound clinic regardless of a procedure being done or not?
The clinic is a hospital outpatient department and is billing every patient 99211 and adds modifier 25 if a procedure is done (this is for the facility charges). The physician's charges are entered separately.
My understanding is that this is not appropriate to do, as a matter of practice, on each and every visit unless the E/M is separately identifiable. But I am wondering if there may be some different rules where this is a facility charge.
The clinic manager argues that we are charging for our nursing/facility resources for each visit that are not specifically related to the procedure (vitals, review of history etc.). My argument is that these are not separately identifiable and are considered included in the facility payment for the procedure.
Example:
Established patient returns for wound debridement
Facility charges: 99211-25, 11040
Physician charges: 11040
The clinic is a hospital outpatient department and is billing every patient 99211 and adds modifier 25 if a procedure is done (this is for the facility charges). The physician's charges are entered separately.
My understanding is that this is not appropriate to do, as a matter of practice, on each and every visit unless the E/M is separately identifiable. But I am wondering if there may be some different rules where this is a facility charge.
The clinic manager argues that we are charging for our nursing/facility resources for each visit that are not specifically related to the procedure (vitals, review of history etc.). My argument is that these are not separately identifiable and are considered included in the facility payment for the procedure.
Example:
Established patient returns for wound debridement
Facility charges: 99211-25, 11040
Physician charges: 11040