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Clinic and MD E&M

  1. #1
    Location
    Greater Atlanta
    Posts
    37
    Default Clinic and MD E&M
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    We aren't technically an ASC but a outpatient within a hospital, but I think you're the best group to answer this.

    Scenario:
    Established patient has a scheduled office visit and within the visit, the MD decides to do an analysis of the patient's pump. No refill. For the MD charges, we would use 62367 and whatever E&M level it was with the modifier 25.

    What codes would you expect on the clinic side?

    Thank you!
    BHouston,MBA,CPC,CPC-H,CPC-I,CCS-P
    Inpt & Outpt Coder

  2. #2
    Location
    Columbia, MO
    Posts
    12,570
    Default
    A facility level E&M based on the facility criteria (99211-99215) with a 25 modifier and the 62367, I did not look the code up so I am assuming that is the right code for a pump refill.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Location
    Greater Atlanta
    Posts
    37
    Default
    Wouldn't the facilty fee be incorporated in the procedure charge?
    BHouston,MBA,CPC,CPC-H,CPC-I,CCS-P
    Inpt & Outpt Coder

  4. #4
    Location
    Columbia, MO
    Posts
    12,570
    Default
    not necessarily it follows the same criteria as the physician usage.

    Debra A. Mitchell, MSPH, CPC-H

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