Wiki Provider Base Billing

[embs2006]

I need help with what can and cannot be billed out on the facility side and professional side.

I have been told that if a patient is scheduled to have an infusion or injection that I cannot bill for an office visit even though a follow up visit is scheduled and the physicians see them before or after their injection or infusion.

I thought the the office visit would go out on the professional side and the infusions and injections would go out on the facility side.

I majorly need some help with this, I have never billied for a provider that is hospital proivder base.

This physician has patients that get infusions, injections, and just plain office visits. If there is a website you can direct me to would be greatly appreciated also.

Thanks

 

[Pam Warren]

Provider based billing is a process whereby your medical practice is owned by the hospital such that the practice is deemed a department of the hospital. This means that you can bill both a professional charge on the 1500 with a corresponding (not necessarily matching) facility charge on the UB. In your case, if I understand it correctly is that this is more of an unbundling issue. Unless your provider is personally performing the infusion, (which you'd bill on the 1500, and is very unlikely in an outpatient oncology center where they have specially trained nurses for such procedures) you cannot also provide an office visit on the same day as a minor scheduled procedure done in the outpatient department, unless he was assessing for another condition, or a change in treatment. The coding rules that apply in this case don't change just because you're billing provider-based. So even with provider-based billing, you shouldn't bill an office visit on the same day as a scheduled minor procedure unless there's a significant change in the treatment plan or a new problem.

Your provider can (and probably should) see the patient to assess them prior to and maybe even after the infusion, but it's bundled into the minor procedure.