Wiki Outpt x-ray site of service for billing

[vboggs]

Hi - I am trying to locate documentation for the following scenario:

A patient is seen in our outpatient clinic (not based in our hospital) and the physician writes an order for an x-ray. The patient then physcially comes over to our hospital to have the x-ray done. Is it appropriate to bill the x-ray on the clinic visit since our clinic is owned by the hospital? Or, since the patient is physically presenting to our hospital for the service after the office visit is done, should we bill the xray as a completely separate encounter? As a side note, our radiologists are not employed so they do their own billing. What I'm looking for specifically is documentation on the appropriate handling of the technical portion of the x-ray itself.

My initial thought is for two separate visits to be created (one for the office visit and a separate one for their radiology encounter), but I have not had luck finding the appropriate documentation to support that yet. Any thoughts or guidance is greatly appreciated.

 

[thomas7331]

It would depend on what payer you are billing and whether or not your clinic considered is considered a provider-based outpatient department. If it is, and you're billing Medicare, I'd refer you to Medicare OPPS rules, maybe starting with Medicare Claims Processing Manual, Chapter 4. Generally speaking, all facility charges on the same date are combined on the same claim. This is probably a question best addressed to the hospital's billing department and/or provider contracting representatives, though, as individual facility policies and regulation can vary.