Wiki Inpatient coding for procedure

[prirs1985]

If doctor performs procedure for hospital inpatient, which codes are used for coding, from ICD-10-PCS or CPT?

 

[Pam Warren]

If you are billing the physician's services, you would use CPT. If you are billing that very same service, but for the hospital's portion, you would use ICD-10-PCS.

 

[Munzueta]

Hello,

keep in mind the because we code a procedure for the hospital it doesn't mean is "inpatient" coding.

Any place (clinic, hospital or any type of healthcare facility) that uses a CPT book or HCPCS to code is outpatient coding even for hospital services.

ICD-10-PCS is precisely for inpatient coding, now when it comes to understanding the billing portion just as stated by Pam, when coding especially for the doctors services or the "professional" services you are coding CPT. When you are billing for the hospital (which includes the hospital bed, room, nursing services, medication, monitoring) anything that is not the doctor's services, then a UB04 bill is created for this services as for outpatient (CPT) will be the CMS-1500.

 

[dsant69]

If you are billing the physician's services, you would use CPT. If you are billing that very same service, but for the hospital's portion, you would use ICD-10-PCS.

I have a question that hopefully you can provide some clarity to;
OK, a provider (surgeon?) uses the hospital facilities and bills his portion on 1500, facility bills their portion on UB,...How would you code if the physician was employed by the hospital? Are the PCS codes global? Do PCS codes identify professional services and technical services? Or does a hospital generate a professional claim (1500) on behalf of the provider?

 

[Pam Warren]

I have a question that hopefully you can provide some clarity to;
OK, a provider (surgeon?) uses the hospital facilities and bills his portion on 1500, facility bills their portion on UB,...How would you code if the physician was employed by the hospital? Are the PCS codes global? Do PCS codes identify professional services and technical services? Or does a hospital generate a professional claim (1500) on behalf of the provider?

Physician services, whether employed or otherwise, are always billed on the 1500 form, using CPT. (the exception to this might be for critical access hospitals, but that's not the norm).

The PCS codes are for facility charges only and are always bulled on the UB. That doesn't cover the physician.....it's the charge for the resources used (nurses, technicians, electricity, etc.) for providing that surgery to you at the hospital. The CPT charge is for the actual work done by the surgeon.

Depending on your physician's employment arrangement, he may have his own billing people in the office, or the hospital billers would submit claims for him. Usually it's the latter for employed physicians.