What codes do outpatient hospitals use to bill for procuedres??

l1ttle_0ne

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This is probably a strange question. But I'm wondering how a hospital bill's for outpatient procedures?? Would they be billing regular CPT codes?? We are having Regence take back money from us (the physician office). We billed a 52356, and apparently so did the hospital. Regence is stating that we can't both bill for the 52356. I talked with someone at the hospital, and she say yes they can. I've never had any experience billing for outpatient hospitals. So I'm just asking would a hospital bill with CPT codes such as 52356?? I'm trying to fight Regence on this, because if they should be taking back money from someone it should be the hospital. We didn't bill anything wrong... If someone could answer this question I'd appreciate it.

Thank you!
 

mitchellde

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This is probably a strange question. But I'm wondering how a hospital bill's for outpatient procedures?? Would they be billing regular CPT codes?? We are having Regence take back money from us (the physician office). We billed a 52356, and apparently so did the hospital. Regence is stating that we can't both bill for the 52356. I talked with someone at the hospital, and she say yes they can. I've never had any experience billing for outpatient hospitals. So I'm just asking would a hospital bill with CPT codes such as 52356?? I'm trying to fight Regence on this, because if they should be taking back money from someone it should be the hospital. We didn't bill anything wrong... If someone could answer this question I'd appreciate it.

Thank you!

Hospitals bill using CPT codes. They are reimburse for the technical component. When the provider performs a procedure at the facility the the physician bills using the same code and is reimbursed the professional component. You must use the POS of either 22 if this was done as an outpatient or 21 if the patient was inpatient. You are correct to fight this.
 

l1ttle_0ne

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Hospitals bill using CPT codes. They are reimburse for the technical component. When the provider performs a procedure at the facility the the physician bills using the same code and is reimbursed the professional component. You must use the POS of either 22 if this was done as an outpatient or 21 if the patient was inpatient. You are correct to fight this.

Thank you, that is what I thought! Does the hospital have to bill with any modifier to show they are the technical component?? Below is what the Regence rep is stating, and it makes me think that possibly the hospital is missing a modifier?? But I'm not sure since I don't bill for them.

"I looked over both claims and the problem is coming in on the fact that both the provider and facility are billing the 52356 as global. We can’t pay two providers global for the same procedure. If your provider did the entire procedure and not just a portion then I would suggest that you submit an appeal for it to be reviewed. Provide supporting information that shows that your provider did global and should be paid as such and then it can be reviewed."

They are confusing me! I know when we bill for our surgery center we bill with an SG, is there something like his for the hospital??
 

mitchellde

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The only codes we ever used a TC modifier with were radiology codes since a professional read needed to be done and typicall could be performed by an outside provider. Other wise surgical procedures, the facility does not use the TC modifier, it is automatic that being submitted as a facility claim with the correct revenue center for outpatient the are automatically reimbursed the technical portion. The physician, then billing with POS of 22 or 21, if the patient is inpatient, are auto paid the professional component only. The only way the facility would be paid the professional component would be if the facility coded the procedure twice with two different revenue code, one for the or suite , and a revenue code for physician service. The only way the provider would be billing for the technical would be by using the POS of 11.
 
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