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Out Pt Hospital Coding- need a CPC-H

  1. #1
    Location
    Kansas City, MO
    Posts
    431
    Default Out Pt Hospital Coding- need a CPC-H
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    I have always worked in physician billing, and coded/billed for the professional services. Ive had a project given to me that involves hospital coding, of which I have no experience.

    We have a "Specialty Clinic" at the Hospital where the specialists see their patients, they also do infusion/chemo services there, and minor procedures.

    Our billing office, has always done the professional billing, but is considering taking on the hopital services as well....its a wierd relationship, so we wont go there...

    I just need someone to give me the basics of how hospital coding/billing works in these cases...the doctor bills the e/m and procedure...the hospital bills a room/facility charge??? For nursing care?? Does anyone know about the "point system" that is used for nursing care to assign a level of care??
    Or say a patient comes to this out patient clinic and sees a dermatologist who charges 99204-25 and 11426....what would the hospital charge???

    Anything would be helpful here!

    any links to educational info would be great as well!!

    Thank you!
    Last edited by LindaEV; 01-08-2010 at 01:51 PM. Reason: Add addl info

  2. Default
    Hospitals are instructed to use the CPT book to code just as if you were a physician with the appropriate revenue code for where the service was given. So in other words, if a doctor not employed by the hospital, both the physician and the hospital should be billing identical. One for the professional and one for the technical component. The E&M is tricky. The guidelines state that each hospital should create a level charge protocol for ER, Clinics, etc... corresponding to the instructions from AMA and the E&M guidelines from medicare.

  3. #3
    Location
    Columbia, MO
    Posts
    12,560
    Default
    The point system you are referring to is your facilities system to determine the facility E&M level you will need to get a copy of this and learn how to use it to arrive at the facility E&M . Thw E&M levels do not need to match to the physician level so while the physician can have a level 4 new patient the facility may have a level 2 estb patient. Also the facility could have more than one E&M for the same patient on the same day so you will need not only the 25 modifier bu the 27. The procedure code the physician used is suppose to match the facility procedure code. That does not mean you just take the physicians procedure code and apply it as they could be incorrect. There is a lot of complexity to facilty coding. You should do some reasearch on facility coding to learn all the ins and outs.

    Debra A. Mitchell, MSPH, CPC-H

  4. #4
    Location
    Kansas City, MO
    Posts
    431
    Default
    Quote Originally Posted by mitchellde View Post
    The point system you are referring to is your facilities system to determine the facility E&M level you will need to get a copy of this and learn how to use it to arrive at the facility E&M . Thw E&M levels do not need to match to the physician level so while the physician can have a level 4 new patient the facility may have a level 2 estb patient. Also the facility could have more than one E&M for the same patient on the same day so you will need not only the 25 modifier bu the 27. The procedure code the physician used is suppose to match the facility procedure code. That does not mean you just take the physicians procedure code and apply it as they could be incorrect. There is a lot of complexity to facilty coding. You should do some reasearch on facility coding to learn all the ins and outs.
    Debra, thanks for your input. My intent is to absolutely do some research, but can't seem to find any resources online, do you know of any, or can you reccommend any good courses or books?

  5. #5
    Location
    Columbia, MO
    Posts
    12,560
    Default
    you are probably using the wrong key word .. look under outpatient APC or APG or OPPS (outpatient prospective payment system) most of these key words will helps link you to some valuable resourse. That is what I did many years ago and it really helped me.

    Debra A. Mitchell, MSPH, CPC-H

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