Wiki Hospital Billing

[kkremer]

I have several hospital claims that have clinical codes on them (99211,99213, etc.) The patient's are outpatient and usually are there for lab work or chemo. Can the hospital bill this code on the same day when the patient has an office visit?

If the patient is there for lab work why is there a 99211 code attached to the visit? All I can think of is the oncology office is considered part of the hospital so they are charging an office visit at the hospital!

I feel we are incorrect to process the claim because it seems to be double dipping. I did not take classes on hospital coding. Maybe I should have.

Most of our patient's are Medicare. I appreciate any help you can give me.

 

[espressoguy]

I suspect that this is ok. This is one of the differences between Hospital Outpatient billing and Physician Billing. Your Oncology department may be classified as a Hospital Outpatient Department (HOD), or may be a Hospital Based Billing (HBB) clinic. While there are some differences in the 2 classifications, for the purposes of your question, they work the same. There is a professional (physician) charge and there is a facility charge. In the case you mentioned the 99211 is the facilty charge for the lab work.

It can be kind of confusing for coders who are used to straight physician billing. I code for 3 clinics within our hospital, 1 physician clinic, 1 HOD, and 1 HBB. Fortunately, I don't have to code the facility side, but I work pretty closely with the facilty coders and probably know just enough to be dangerous.