ED coding profee vs facility

rmooney1114

Networker
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Monson, MA
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I have a question, when billing for an ED E/M would you bill for any vaccines or medications given in the ED or would that be billed under the facility side? What about vaccine administration code i.e.90471, 96372, would those be billed through the facility side or would the provider also bill for that under the professional side.
Thank you
 

mitchellde

True Blue
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Columbia, MO
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in the ED the ED provider can bill only for the services they personally performed. Most services like injections are performed by ED staff and are not billable by the provider.
 

rmooney1114

Networker
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Monson, MA
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Thank you so much, that is what i thought, but i needed confirmation. Do you know where i could find any resources or articles that state that?
Thanks again!
 

mitchellde

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You can look up outpatient facility billing. However it really has to do with who owns the resource that has been consumed. The facility bought the supplies and drugs. The facility pays the salaries for the staff personnel, as well as all the other overhead expenses, there is nothing left for the physician to be able to bill for when they work in the facility setting, for all that provider owns is him/her self.
 

thomas7331

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This is addressed in this MLN Matters Article:

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/se0441.pdf

See the paragraph on Hospital or SNF on page 2: "payment for all services are made to the hospital or SNF by a Part A Medicare Administrative Contractor (MAC) (except for certain professional services personally performed by physicians and other allied health professionals). Therefore, incident to services are not separately billable to the Part B MAC or payable under the physician fee schedule."

This is also addressed in more detail in the Medicare Claims Processing Manual and Medicare Benefit Policy Manual if you need more in-depth documentation.
 
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