Wiki urgent care professional fee

[hspruill]

I am an ops coder for an acute care hospital. our hospital has grown and opened 4 urgent care centers for which we are coding facility and pro fee. when a patient has minor procedures done in the urgent care, we are coding/charging those cpts to the facility side and have been instructed to only charge an e/m for the profee side. is this correct? does the doctor still get credit for time and skill spent on the procedure that he/she performed? should the physician be able to bill the same cpt as the facility with some type of modifier? This is fairly new territory for my coworkers and me and we have been given very little instruction. we want to code correctly for both sides and not take away anything that the physicians should be getting paid for.

 

[coder21]

The urgent care I work for we code the e/m plus all the procedure but we where not hook to an hospital. But in the Ed's don't the providers get to code the procedure for both facility and pro fee?

 

[thomas7331]

Normally you would charge a professional fee for the services that were performed - I can't think of a reason why you would not, or why you would only charge an E/M service and not a procedure. I do know that some payers bundle urgent care services into a single payment that includes everything and may require all of the charges on a single claim, but that is a billing requirement and should not determine how you code the charges. There should still be separate professional and facility fees involved, as an appropriate representation of what was done.

 

[hspruill]

thank you both. and yes when I have gone to ED I get a bill for both facility and physician. and I keep thinking that they are having us do it wrong by only charging the e/m. no wonder the doctors are up in arms about their rvu's I will definitely do some more research and take this to the higher ups. thank you again.