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Thread: In Office Billing of ESI

  1. #1

    Smile In Office Billing of ESI

    AAPC: Back to School
    Our pain management doc was told to take over the facility billing for his practice. Currently the doc only bills for the professional charges, but wants to know what to bill for the facility side (again procedures done in office) and if those charges are even reimbursable or bundled into the professional charges. Can the doc bill for both the professional and technical/facility charges? And what codes would he need to bill for the "in office" facility charges? Any help would be appreciated !

  2. #2
    Join Date
    Apr 2007


    I could be wrong on this...I dont beleive the office is considered a "facility". I believe that you have to have special licensing for "facility" billing. Again, I could be wrong.

    Anyone else have any input on this?

  3. #3


    The clinic is licensed thru Medicare as a "non ASC"....All procedures are considered done in office.

  4. #4
    Join Date
    Apr 2007
    Palm Beach


    If there is a facility licensed, you would need to bill under the facility name with the same procedure code(s). If there isn't a facility licensed, then the physician should receive a higher reimbursement for the site of service differential.

  5. #5


    You can only bill a Technical Component if you are the owner of the machine. I don't see why he can't bill for his services also.

  6. #6
    Join Date
    Apr 2007
    Athens, Ga.


    bill in office ESI's as follows:

    1. procedure code
    2. flouro code (without the -26 or -tc mods)
    3. supplies

    you would make sure to send this claim with POS code 11. This will prompt the higher payment for the combined professional and facility charges.

    if you have any questions email me at walkerb@tameyourpain.com

    hope that helps!

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