Wiki Outpatient facility E/M

[becka95]

I'm looking for a reference that outlines what is included in the facility E/M. We have a score sheet (AKA clinical level of care) but I'm looking for a reference that states what is considered "facility resources." I am putting together material for education on E/M's, including the use of modifier 25.

There is an article in the AAPC learning centers however, it's not recent. Most references I find via Google search brings me to Pro E/M's, not facility.

 

[Pam Warren]

Well, if you find one, that would be awesome, and I'd owe you dinner. The guidance isn't really out there. I'm assuming that this is with regards to a provider-based situation.

Medicare says only that you devise a system and stick with it consistently. Commercial payers don't recognize provider-based billing.

Facility resources are anything that isn't an MD/DO, APRN, PA, CNM, CRNA, Ph.D., Psy.D. LCSW or licensed masters level behavioral health clinician. In short, anyone who doesn't bill directly on a 1500 form. Ancillary staff (nurses, medical assistants), supplies and the work that they do are generally calculated as facility resources--but not for outpatient hospital clinics.

The E/M visit facility code is G0463 except for Emergency Department, so leveling isn't necessary in outpatient clinic E&M services. That code was effective in 2014. ACEP has a good resource for levelling ED codes on the facility side.