Facility codes - HELP!

[kimsue63]

Hi,
Hoping someone who does facility billing can help. I have only done physician coding and so I am somewhat lost as to how the facility bills on their side. An example, if our physician does a Norwood procedure, 33619, what does the hospital bill? The same code? I have one of our physicians asking me and I have no idea.
Thanks!
Kim

 

[cordelia]

Yes, as a facility coder, we code the CPT for outpatient procedures and ICD 9 procedure codes for inpatient.

Cordelia, CCS, CPC

 

[kimsue63]

So, if the patient is an inpatient and has the surgery the facility does not report the CPT at all?

 

[kevbshields]

For an inpatient, the hospital would report a code, just not a CPT.

In addition, just because the facility and physician coder are reading the same report does not mean they arrive at the same CPT code. I've seen this happen many, many times. If the facility is using a particular encoder, that usually explains how it arrived at an improper code.

 

[mitchellde]

That is correct they use an ICD-9 Volume 3 code for the procedure, with ICD-10 CM the facility inpatient will use ICD-10 PCS codes for the procedure the outpatient will continue to use CPT codes.