Hi, I am looking at my own bill for services in a hospital OP dept. I had a new patient OV and she recommended an abdominal x-ray, so I went to Radiology and had that done on the same day. I see the OV charge, two x-ray charges (can't see the details, assume one is TC and the other 26) and then, and this is what I am questioning, a " facility E+M Level 2 charge" 99212. Is that normal? What would that be for??
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Facility E+M for an x-ray?
- Thread starter Cmama12
- Start date
Is your physician's office part of the hospital? It sounds like the facility E/M corresponds to the physician visit.
Pam Warren
True Blue
Provider Based billing. It's when a practice is deemed a department of the hospital, and as such bills as if it is an outpatient hospital service under OPPS for the facility charges and PFS for the physician charges. Your physician charge will be less since it's provided in a hospital setting, but with that, they'll also bill a hospital charge for the hospital department overhead.
If you're going to HealthCon; I am presenting on this very topic on Tuesday, session 5E.
If you're going to HealthCon; I am presenting on this very topic on Tuesday, session 5E.
The APP billed a new patient 99204 for my visit with her. The " facility E+M" is under the radiologist.
Thanks for your reply. No, I unfortunately won't be there. So if I am understanding correctly, it's really just a facility charge? How can they use an E+M for that? This is what I am having trouble with.. when no face-to-face service was provided, no MDM, etc. Why not just call it a facility fee or equipment fee and leave it at that? I guess this is my first hospital x-ray, so although I expected the TC/26 for the x-ray, I was surprised and still confused by a 99212 from someone I didn't see
Thanks for your reply. No, I unfortunately won't be there. So if I am understanding correctly, it's really just a facility charge? How can they use an E+M for that? This is what I am having trouble with.. when no face-to-face service was provided, no MDM, etc. Why not just call it a facility fee or equipment fee and leave it at that? I guess this is my first hospital x-ray, so although I expected the TC/26 for the x-ray, I was surprised and still confused by a 99212 from someone I didn't see
G0463 is the HCPC for "Hospital outpatient clinic visit for assessment and management of a patient."
It's possible that your insurance company doesn't take the G code and wants an E/M code instead?