Wiki Clinic and MD E&M

[Breezy]

We aren't technically an ASC but a outpatient within a hospital, but I think you're the best group to answer this.

Scenario:
Established patient has a scheduled office visit and within the visit, the MD decides to do an analysis of the patient's pump. No refill. For the MD charges, we would use 62367 and whatever E&M level it was with the modifier 25.

What codes would you expect on the clinic side?

Thank you!

 

[mitchellde]

A facility level E&M based on the facility criteria (99211-99215) with a 25 modifier and the 62367, I did not look the code up so I am assuming that is the right code for a pump refill.

 

[Breezy]

Wouldn't the facilty fee be incorporated in the procedure charge?

 

[mitchellde]

not necessarily it follows the same criteria as the physician usage.