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Consult visit in a Dr's office adjacent to a hospital

  1. Default Consult visit in a Dr's office adjacent to a hospital
    Medical Coding Books
    Hi there,

    Can someone please help me. I have a situation where a pt has a consult visit with a specialist, who has an office adjacent to a hospital. Pt was billed for the office visit by the physician's office, and another bill from the hospital that the physician's office is connected to. Pt never set foot in the hospital building, just the physician office. Also, pt had to pay copays for both the physician and the hospital for the same consult visit. Rev code used was 4510372 - New Outpt visit level 3, billed by the hospital. 99244 was the CPT Code used for the actual consult with the physician.

    Is it legal to get charged by both the physician's office and the hospital in this case, and have to pay 2 co-pays?

  2. #2
    If the clinic is sponsored by the hospital, then yes. What it is , is a split charge sitation. The "facility" portion is paid to the hospital and the "pro fee" is paid to the doctor. That is a common scenario. As for the copay situation, that is set by the insurance companies.

    The facility portion covers things like rent,utilities,staffing,security, etc provided by the hopital to the clinic. The pro fee would be for the physician.

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