Wiki Physician coding different than facility coding

[GretchenC123]

Is it fairly common for an ED provider to bill out a 99284 when the facility bills a 99283? If so, what criteria is different for the provider than for the facility?

 

[thomas7331]

Yes, it's common to see this because facilities use different criteria for choose a level than do physicians. Physician levels are based on CPT code description, e.g. level of medical decision making by the professional provider. Facilities assign their codes based on hospital resource utilization.

 

[GretchenC123]

Thank you for that information. Appreciate it.