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Consults-RN HELP HELP HELP!!!

  1. #1
    Location
    Billings, MT
    Posts
    50
    Default Consults-RN HELP HELP HELP!!!
    Medical Coding Books
    I am at a Radiation Oncology Clinic. It is an outpatient Hospital place. I have a physician that bills his professional fees through his own company and tech. fees are through the hospital. On the same day that the physician sees a patient for a consult I have an RN charging a level I, II or III consult fee for her time going over meds, histories and education. In visiting with the billing dept. in the hospital they said it is a room fee. Is this okay?????? Thank you for any help!!
    Jennifer Pfister, CPC

  2. #2
    Location
    Columbia, MO
    Posts
    12,836
    Default
    Yes it is the way the hospital does it.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Location
    Billings, MT
    Posts
    50
    Default
    What code is being used for a room fee then
    Jennifer Pfister, CPC

  4. #4
    Location
    Columbia, MO
    Posts
    12,836
    Default
    hospital use the E&M codes for the facility fee(room fee). this is the way it is done since 2000 when APCS desended. Each facility is in charge of creating their own system of guidelines to determine the E&M level for the facility charge. They do not use the same criteria as the physicians. Most eventually opted for a point system and then so many points is a 99211, 99212 etc. No two facilities are the same in their system. This is why you will need to get a copy of theirs to use for the clinic E&M. Also a facility is allowed to have multiple E&M levels on the same day so you may need to use the 27 modifier and if you have more that 1 E&M in the same revenue center on the same day yopu will need a G0 condition code on the claim. Also if one encounter for that patient has a significant procedure then all E&Ms for that day(for that patient) must have a 25 modifier. For example
    a patient is seen in the derm, cardiology and internal medicine departments. then that evening comes to the ER for a laceration repair
    the facility may have
    rev code CPT code Modifier
    510 99212 25
    510 99214 25 27
    510 99212 25 27
    450 99282 25 27
    450 12002
    also a G0 condition must be applied for all the E&Ms to process.Oh and there are now HCPC II codes for the ER but my book is taking a vacation in hawaii so I do not have that in front of me.

    Debra A. Mitchell, MSPH, CPC-H

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