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Er professional fees/facility fee

  1. Default Er professional fees/facility fee
    Medical Coding Books
    If i am billing for the er facility and also for the er physician and we have a person who comes in with a laceration of a forearm..ie they cut it on a piece of glass and come in for stitches....can i bill an er level for the physician and also the procedure of laceration repair =====and=== an er level for the facility and laceration repair for the facility????

    Thoughts?? I know i can bill a laceration repair by physician and an er level for the facility but i have a supervisor who says that i should be doing all four charges. I dont feel i have a seperate and identifiable problem in order to bill the er pro fee for the dr.

  2. Default
    For Pro Fee billing for the physician services, you should be able to have an e/m level for the services rendered and if a procedure is also performed a modifier -25 applied to the e/m and cpt code for the appropriate laceration repair.

    I do not do hopsital(facility coding), but ideally the hospital also has an e/m often done by nursing and then the capture of the repair along with any "supplies". So i would assume the answer to your question is if you are doing both sides then you should ideally have 4 codes, 2 for each side.

  3. #3
    Location
    Dover Seacoast New Hampshire
    Posts
    2,028
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    Your supervisor is correct.....probably how she got to be the supervisor!

    Anyway, you're basically billing for two 'sides'...the professional (on the 1500) and the facility (on the UB). For each side, you report similar circumstances.

    You'd bill the E&M and lac repair for the physician, so he gets paid for his work. You bill an E&M (level charge) for the ED and the lac repair for the ED, so that the facility is reimbursed for overhead and supplies. Separate and identifiable doesn't apply in the way you are thinking. It would apply if the E&M wasn't separately identifiable from the lac repair.
    Pam Brooks, MHA, COC, PCS, CPC, AAPC Fellow
    Coding Manager
    Wentworth-Douglass Hospital
    Dover, NH 03820

    If you can dream it, you can do it. Walt Disney

  4. Default
    I do understand that there is a facility and physician charge. However, if a patient comes in with a laceration to the arm and the physician repairs the laceration. What warrants the E&M? There is no separate identifiable problem. Now if the patient has an ear infection too...then I see the need to charge for the E&M. I have been a coder for 20 years and this has been hounded in me for so long....I have great difficulty in charging for 4 procedures...when a laceration comes in...it gets a facility fee and a profee for MD and that's it. It just seems to be double billing to me.

  5. #5
    Location
    Columbia, MO
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    12,913
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    Quote Originally Posted by josiew3 View Post
    I do understand that there is a facility and physician charge. However, if a patient comes in with a laceration to the arm and the physician repairs the laceration. What warrants the E&M? There is no separate identifiable problem. Now if the patient has an ear infection too...then I see the need to charge for the E&M. I have been a coder for 20 years and this has been hounded in me for so long....I have great difficulty in charging for 4 procedures...when a laceration comes in...it gets a facility fee and a profee for MD and that's it. It just seems to be double billing to me.
    You are correct, while it is possible to have 4 charges here the criteria must be met. If you have an evaluation of the injured area only with a lac repair then you probably do not have documentation to support the professional E&M, also on the facility side there must be documentation of the utilization of resources beyond what is needed for the lac repair. It is not an automatic that you always have an E&M in the ED setting. So it will depend on the documentation and for the facility it will depend on the nurses documentation and whether the elements of the facility E&M tool have been met for that level. Without the documentation for both sides we could not tell whether this is a total of 4 charges or 3 or 2.

    Debra A. Mitchell, MSPH, CPC-H

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