Wiki Emergency Room Facility Billing

[mbarbour]

Our ER physicians do not work for the facility where they see patients. They are independent contractors. We know the professional side of coding, but have a question about the facility side. If we bill a 99281-99285, does the facility also use theses same CPT codes? If so why?

 

[mitchellde]

Yes the facility will use the same E&M codes for the facility component. They do this to obtain reimbursement for the use of the facility and the facility resources such as nurses. They use a different criteria to assign the level and it may not match the same level billed by the physician. Without the ability to bill for the use of the facility, the hospital would not be able to have an ER or outpatient departments.