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Facility Billing concerning E&M and debridement

  1. #1
    Default Facility Billing concerning E&M and debridement
    Medical Coding Books
    I am running into a problem with reconciling our E&M visits with the hospitals. Our Doctor will show an E&M visit as well as a debidement on the same day but the hospital will not code the E&M only the debidement charge. I thought we should match. Any help would be appreciated.

    GMitchell

  2. #2
    Location
    Seacoast- Dover New Hampshire
    Posts
    609
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    Physicians in our facility give us their charges(coders) wereas the hospital bills for the facilities.
    Karen Barron, CPC
    Hampton New Hampshire Chapter

  3. #3
    Default
    Should not the billing match?

  4. #4
    Location
    Columbia, MO
    Posts
    12,526
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    The procedure code you use must match the facility, however the E&M does not need to match. The hospital has completely different criteria for their E&M than what the physician uses so it is expected that the visit levels will be different and only by coincindent will they match. The procedure code however is required to be the same. If you go back to the guidelines for OPPS billing for the hospital you will find where this is stated.

    Debra A. Mitchell, MSPH, CPC-H

  5. #5
    Default
    hello debra,


    Im curious about where i can find this information regarding the opps billing?

  6. #6
    Location
    Columbia, MO
    Posts
    12,526
    Default
    I got it so long ago. you can do a web search and find it , look under OPPS and also APCs, also look in the CMS website. I did a ton of research on this many years back to assist the facility I worked in and also did a few national presentations. Since then I have just kept up with the changes. Do some looking and if you cannot find what you need let me know in a PM and I will see what I have still retained or if I can find something you need.

    Debra A. Mitchell, MSPH, CPC-H

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