Revenue Code 510 and CPT 99204 same date of service

[Anduiza05]

hello,

I have a hospital that is billing the following scenario

Facility (1st NPI) (DOS same)
Revenue Code 510 POS-22

Physician (2nd NPI) (DOS same)
99204 POS-22

Can the facility bill for the outpatient Rev code 510 and the physician bill 99204 for the same DOS and get paid for both. I am new to revenue coding and I am not sure if this is correct. Any help would be really appreciated and if you have any resources to validate would be great. As coders you know how doctors are they want proof that we are right.

thanks
theresa

 

[CodingKing]

0510 doesn't include the professional component. The payer i work for it depended on the contract, some facilities we did not pay extra for the 510 (especially those who used employed physicians) and some we did. We always paid the physician though.

 

[thomas7331]

This is correct coding for physicians who practice in a "provider based" outpatient location, i.e. a location that is owned and operated by a hospital. The revenue code 510 is for the facility costs including the use of the space, materials and staff. For payers that reimburse with a site of service differential, the physician's fee for 99204 will be lower with place of service 22 than if they performed in their own office and billed with 11 since the payer is not reimbursing the physician for their own overhead costs and that portion is being paid to the facility instead. As the previous post mentions, not all payers recognize this arrangement and may just pay the full fee to the physician and deny the facility charge.

 

[Anduiza05]

revenue code

thank you all for your input do any of you know where I can find documentation to support this information? CMS, AMA, AHIMA, AAPC?

 

[mitchellde]

You might try researching facility outpatient reimbursement. OPPS. The facility needs to be paid for the use of the facility and supplies and staff. Usually the facility bills on the UB and uses the revenue codes to indicate the department in the facility the patient was in. 510 is the outpatient clinic, 450 is the ER and so on. The revenue code is usually accompanied by a CPT code to indicate the level of the service provided. For visit level the facility uses an entirely different criteria than the physician so they do not necessarily match. Procedure codes should match. The physician claim will be reimbursed the provider professional fee only and the facility will be reimbursed the facility overhead only. In some areas the facility will put both the facility charges and the physician charges on the same Claim using a different revenue code to indicate physician charge. This looks confusing when you see what appears to be duplicate charges, however the different revenue codes should tell you that different portions are being billed out.