Again facility is different. There so far have not been codes created for the facility to use to capture an encounter. There are now HCPC II codes for ER encounters but still several payers do not recognize them. The E&M code for the facility does NOT have the same guidelines as the physician. The facility must account for their utilization of resources using this E&M code. The nurse, the patient transporter the lab runner, the lights, exam room supplies... all of these things and more are consumed by the patient when they present to the facility and the only way the facility can communite this consumption of resources to the payer is via the E&M code. There is absolutely nothing wrong with the facility charging a higher E&M than the physician or a lower one. The levels are not expected to match. so when you say it does not match what is outlined for an E&M, you are comparing apples to oranges. The physician must comply with 95 or 97 guidelines for HX, exam, MDM... the facility must adhere to their own guidelines they create and hx, exam, MDM ... does not enter into their equation.
Debra Mitchell, MSPH, CPC-H
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