Wiki Recovery Room Phase I & II charges

[lizzetterubio@yahoo.com]

I’m committed in trying to understand the Recovery room Phase I and II charges in a hospital and hospital outpatient surgery setting for Cardiac Catherization Lab.

When are these appropriate to be billed? Whom to charge them on? What procedures? In or out patients? Diagnostic and interventions? Peripheral and/or cardiac only?
I appreciate any feedback.

Thank you in advance

 

[thomas7331]

There aren't really any coding guidelines or rules on how hospitals are supposed to charge - in my experience, every facility really develops their own internal procedures for these types of questions. Hospital charges are largely based on resource utilization rather than coding principles. Recovery room charges would usually be based on the amount of time spent by the patient in that location and the intensity of the services provided there, not on the type of procedure that was performed.

Typically, charges for ancillary and incidental service such as use of the recovery room will have no impact on reimbursement - Medicare and many other payers reimburse hospitals based on APC (for outpatient) or DRG (for inpatient) case rates which are calculated based on the patient's conditions and/or procedures performed during the encounter and charges rarely make a difference in the rate, so these charges are rarely, if ever, scrutinized or audited.

 

[lizzetterubio@yahoo.com]

There aren't really any coding guidelines or rules on how hospitals are supposed to charge - in my experience, every facility really develops their own internal procedures for these types of questions. Hospital charges are largely based on resource utilization rather than coding principles. Recovery room charges would usually be based on the amount of time spent by the patient in that location and the intensity of the services provided there, not on the type of procedure that was performed.

Typically, charges for ancillary and incidental service such as use of the recovery room will have no impact on reimbursement - Medicare and many other payers reimburse hospitals based on APC (for outpatient) or DRG (for inpatient) case rates which are calculated based on the patient's conditions and/or procedures performed during the encounter and charges rarely make a difference in the rate, so these charges are rarely, if ever, scrutinized or audited.

Thank you for your time and response.