AAPC - Back to school
Results 1 to 2 of 2

Thread: Hospital Based Coding Question

  1. #1

    Default Hospital Based Coding Question

    AAPC: Back to School
    I am looking for assistance with hour an hosptial based facility uses E/M coding when there is no physician present. Per CMS, the FR states that a hospital can use "hospital resources" based on the descriptor in the CPT book. Well the CPT book states "physician face to-face or other qualified health provider. So does this mean the other qualified health provider is only one that can "bill for services" or documents nurses notes (RN). Help!

    Need for proper infusion and -25 E/M coding

  2. #2

    Default Yes, its okay to bill E&M with no physician face to face

    Here are some guidelines with a reference. There doesn't have to be physician face to face to bill a facility E&M. This is from Trailblazers, but it is CMS guidance and the reference is straight from CMS.

    Under the OPPS, unless indicated otherwise, CMS does not specify the type of hospital staff who may provide services in hospitals because the OPPS only makes payment for services provided “incident to” physicians’ services. Hospitals providing
    services “incident to” physicians’ services may choose a variety of staffing configurations to provide those services, taking into account other relevant factors such as state and local laws and hospital policies.

    Facilities should code a level of service based on facility resource consumption, not physician resource consumption. This includes situations where patients may see a physician only briefly or not at all.

    If a visit and another service are also billed, the visit must be separately identifiable from the other service since the resources used to provide non-visit services including staff time, equipment, supplies, etc, are captured in the line item for that service.

    Billing a visit in addition to another service merely because the patient interacted with hospital staff or spent time in a room for that service is inappropriate.

    All services furnished must be medically necessary and documented.
    CMS Pub. 100-02, Chapter 6, Section 20.5.1
    CMS FAQ 8810
    OPPS Final Rule published November 1, 2002 (Vol. 67, No. 212, pages 66790–66793)

    Susan Tompkins, CPC, RN, JD

Similar Threads

  1. Hospital Based Ophthalmology coding
    By ValerieR in forum Ophthalmology/Optometry
    Replies: 3
    Last Post: 03-23-2011, 10:24 AM
  2. time based coding for hospital h&p
    By vhaysom in forum E/M
    Replies: 1
    Last Post: 11-03-2009, 03:35 PM
  3. ER Coding-Hospital Based
    By kishacajun in forum Emergency Department
    Replies: 5
    Last Post: 08-22-2008, 02:10 PM
  4. Er Hospital Based Vs Er Physician Based
    By kishacajun in forum Emergency Department
    Replies: 3
    Last Post: 08-18-2008, 08:42 PM
  5. Er Coding-hospital Based
    By kishacajun in forum Emergency Department
    Replies: 0
    Last Post: 08-18-2008, 03:30 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.