Wiki Billing for outside services

[SSummCCH]

Hello. I need help understanding when and if we can bill for outside services provided to the hospital. In other words, we perform a surgery and an outside company comes in with the Lithotripsy laser and performs the service. We have been told in the past this is part of the OR room charge and not billable. But, I have seen other hospitals bill for this. We also have a company come in and do PICC Line services. This we bill for and we were told by a consultant to bill for that but not the Lithotripsy. I am very confused. Any help is appreciated. Thank you in advance

 

[thomas7331]

Are you talking about professional or technical services? the answer would depend on which type of service it is.

All technical components have to be billed by the facility and can't be billed by outside entities unless a particular payer allows an exception in specific cases. Also, in a facility, professional providers may not bill anything that is performed 'incident to' by ancillary staff - those services are also the responsibility of the hospital. As for professional services, physicians and NPPs from a company outside the hospital and who have facility privileges may perform their services in the hospital and bill those separately.

I'm not sure what service you're talking about regarding having a separate company go into the hospital to perform PICC lines. Can you explain this a little more? Are these physicians or technicians that you are having perform this work?

 

[SSummCCH]

Are you talking about professional or technical services? the answer would depend on which type of service it is.

All technical components have to be billed by the facility and can't be billed by outside entities unless a particular payer allows an exception in specific cases. Also, in a facility, professional providers may not bill anything that is performed 'incident to' by ancillary staff - those services are also the responsibility of the hospital. As for professional services, physicians and NPPs from a company outside the hospital and who have facility privileges may perform their services in the hospital and bill those separately.

I'm not sure what service you're talking about regarding having a separate company go into the hospital to perform PICC lines. Can you explain this a little more? Are these physicians or technicians that you are having perform this work?

Thank you for responding. These are technical services. For the lithotripsy, the technicians come in with the laser for the surgery and perform the service with the laser. We bill out the facility fee and the urologist's professional fee. However, we were told by a consultant that the company that comes in for the lithotripsy is considered part of the OR room procedure fee and should not be billed separate. So they say it is part of rev code 360 and a CPT such as 52648 or 52356. I am questioning this advice. I feel we should build a charge code for the lithotripsy and bill it out as a 270 rev code. But, I want to make sure this is correct. We have gotten bad advice from this consultant before.

For the PICC lines, we are a small rural hospital - 25 bed CAH - and we have a company that comes in and puts in or removes and replaces PICC lines. They send us a bill, we created a charge and we bill that out as a technical component. We bill it under 270 and I am not even sure that is correct.

Thank you for your help and guidance.

 

[thomas7331]

Thank you for responding. These are technical services. For the lithotripsy, the technicians come in with the laser for the surgery and perform the service with the laser. We bill out the facility fee and the urologist's professional fee. However, we were told by a consultant that the company that comes in for the lithotripsy is considered part of the OR room procedure fee and should not be billed separate. So they say it is part of rev code 360 and a CPT such as 52648 or 52356. I am questioning this advice. I feel we should build a charge code for the lithotripsy and bill it out as a 270 rev code. But, I want to make sure this is correct. We have gotten bad advice from this consultant before.

For the PICC lines, we are a small rural hospital - 25 bed CAH - and we have a company that comes in and puts in or removes and replaces PICC lines. They send us a bill, we created a charge and we bill that out as a technical component. We bill it under 270 and I am not even sure that is correct.

Thank you for your help and guidance.

I haven't worked in CAH billing which I know has some special rules, but I can tell you how this has been handled in the facilities where I've worked.

The lithotripsy information you describe sounds correct to me - the laser is part of the equipment used in the surgical procedure in the OR so I agree that this would be part of the OR charges reported under revenue code 360 with the CPT procedure code that matches the procedure documented by the surgeon, and that it how I've seen in done. (The exception would be if the lithotripsy was an ESWL, CPT 50590, then it would be billed with revenue code 790 instead of 360.)

PICC line placements are also surgical procedures so your reporting should be similar, though if they're not done in the OR then you might not use a different revenue code than 360. I've seen this billed with revenue code 361 for a minor procedure or 761 for special procedure room, or even 450 or 459 if the line was placed in the ED. You would be reporting the appropriate CPT code from the range 36568-36573 for this.

Revenue code 270 would an unusual way to report these because that is for miscellaneous supplies, but I don't know that it will really make a difference because the revenue code reports the cost center associated with those expenses and ultimately is not going to affect reimbursement, which is tied to the CPT/HCPCS codes, not the revenue codes, for most payers. You may want to review the UB manual for guidance on the appropriate use of the revenue codes and compatibility of revenue codes with specific CPT/HCPCS codes.

When you say this company puts in and removes the PICC lines, are you paying this company for the physician service involved in these procedures and if so, are you billing a professional claim to recover those costs?

 

[SSummCCH]

I haven't worked in CAH billing which I know has some special rules, but I can tell you how this has been handled in the facilities where I've worked.

The lithotripsy information you describe sounds correct to me - the laser is part of the equipment used in the surgical procedure in the OR so I agree that this would be part of the OR charges reported under revenue code 360 with the CPT procedure code that matches the procedure documented by the surgeon, and that it how I've seen in done. (The exception would be if the lithotripsy was an ESWL, CPT 50590, then it would be billed with revenue code 790 instead of 360.)

PICC line placements are also surgical procedures so your reporting should be similar, though if they're not done in the OR then you might not use a different revenue code than 360. I've seen this billed with revenue code 361 for a minor procedure or 761 for special procedure room, or even 450 or 459 if the line was placed in the ED. You would be reporting the appropriate CPT code from the range 36568-36573 for this.

Revenue code 270 would an unusual way to report these because that is for miscellaneous supplies, but I don't know that it will really make a difference because the revenue code reports the cost center associated with those expenses and ultimately is not going to affect reimbursement, which is tied to the CPT/HCPCS codes, not the revenue codes, for most payers. You may want to review the UB manual for guidance on the appropriate use of the revenue codes and compatibility of revenue codes with specific CPT/HCPCS codes.

When you say this company puts in and removes the PICC lines, are you paying this company for the physician service involved in these procedures and if so, are you billing a professional claim to recover those costs?

 

[SSummCCH]

Hello. The PICC line company comes in and places and removes the lines because our providers are not trained and we do not have the equipment. These are trained RNs who perform this service. We do not bill a professional claim.