Wiki OPPS

[NOTAQUITTER]

I am confused what outpatient prospective payment system coding system is used for.
Is it used for facility outpatient payment or to pay the professionals who render the actual service. To clarify my point I will give this example;
A patient sees the doctor in hospital clinic settings and for example I code 99213 for the doctor to get paid but how hospital or facility gets paid for this visit? Is it the time that the OPPS system is used? and if so what codes should be billed for the facility side of this encounter?
Then there is this HCPCS code G0463 (Hospital outpatient clinic visit for assessment and management of a patient) that is also used in some encounters for Outpatient. So I find the whole thing quite confusing and it is good if anybody can help.

 

[CodingKing]

Facility based office there are 2 bills.

One for professional charges from the physician on CMS-1500 under regular E&M codes and pays off Medicare Physician Fee Schedule.
It pays a lower rate than non-facility based office because of the separate bill from the hospital for the facility expense. Its called site of service differential.

Second bill from the Hospital on UB-04 for the facility expense. For Medicare its reimbursed under OPPS/APC Methodology. G0463 triggers the payment under OPPS