Wiki Wound Healing Center, and Podiatry

[Peggy62]

I code for our Wound Healing Center. We've recently acquired a Podiatrist who will be working out of that department, and will share the clinical staff with our existing wound care provider. When he sees a pt that is new to him, but established to the Wound Healing Center, can I still assign an E/M service for the facility for that initial visit since they'll be providing services under the Podiatrist?

 

[thomas7331]

You can assign an E&M code for the facility for the use of the clinic resources used to support the provider's E&M service. But if you're coding facility charges, you would not use the same rules for choosing an E&M as you would for a physician. If the patient is established to the facility, then the facility E&M code should be established even if they are seeing a new provider, and the level of E&M should be based on facility resources rather than on the history, exam and MDM components that would be used for the physician. If a procedure is done that same day, you may be able to assign an E&M for the provider's initial visit for the use of the facility if the resources to support the provider's work for that evaluation warrant it (to support the modifier 25). For example, I would think that if the provider is evaluating a new problem, or establishing a new plan of care for the patient in the medical record, it could be supported, but if that provider is simply continuing and updating the existing plan of care already put in place by one of your other providers, the fact that the patient is new to that provider unlikely to support a separate E&M for the facility.

I'd mention too that if your payer is Medicare or another payer using similar guidelines, all outpatient E&M for facility (other than ER) is now submitted under the same single code, G0463, so there is no real differentiation between new or established or different levels in the code choice.