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Facility E/M Codes

  1. #1
    Default Facility E/M Codes
    Exam Training Packages
    I am having trouble finding info on the correct codes to bill out when a patient is being seen in Radation Therapy, which is part of a hospital. I bill out for the hospital and what I am wondering is when a patient comes for a consult, I was under the impression that as the facility we could only bill out our charges on the establish patient codes. Is this right or can we use the new patient codes? and if we can use the new patient codes, how do we decided if they are new to the facility, do we go by if they been seen in our department or in the hospital its self.

  2. #2
    Columbia, MO
    When you do outpatient facility coding you must get use to the idea that the E&M codes really do not mean the same thing as they do to the physician. Since the new and est patient codes all correlate the same in the facility (ie level 1 is a 1 whether it is new or est and has exactly the same APC value), most facilities inputed only the estb patient codes into their chargemaster. Therefore you need to chech with your supervisors as to whether they want to capture new vs established or default to the estb codes everytime.

    Debra A. Mitchell, MSPH, CPC-H

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