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Thread: Hospital outpatient billing

  1. #1

    Default Hospital outpatient billing

    AAPC: Back to School
    I need help!!! Can we bill a facility charge for the following situation? If yes where can I get thedocumentation to support that..

    We are a hospital based outpatient cancer center. Our medical assistant takes the patient in and draws the patients blood, and does their vitals. The patient then sees a doctor before receiving their treatment, and then the nurse administers the treatment. Our doctors are out sourced MD's. Can we charge for our medical assitants time and our over head usage even though they recieved treatment? HELP!!!!

  2. #2
    Join Date
    Apr 2007
    Columbia, MO


    The usage of an E&M and a procedure in the facility setting to justify the 25 modifier is exactly the same as in the physician setting. Meaning if you can provide documentation to support that the procedure was not a scheduled procedure, if you can provide documentation to support that the resources were above and beyond what the procedure requires for completion. Every procedure code includes in the work performed any services necessary to provide the procedure, such as a brief assessment and taking vitals. So what is documented in excess, and as I stated earlier was the procedure already scheduled.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3


    They are scheduled visits. Everyone is questioning it because they feel we should be able to for the use of the facility.

  4. #4
    Join Date
    Apr 2007
    Columbia, MO


    The visit is scheduled but is the procedure. If the procedure is scheduled the the resources used were the ones planned to be used and are being reimburse with the procedure code(s) you should be billing.
    36415-6 is the blood collection which includes the tech to draw the blood the chemo infusion codes include the nursing time including the taking of the vital signs. what else was done except preparing the patient for the treatment? If on the other hand this was not a scheduled treatment encounter and the staff had to perform extra work not usually part of the treatment encounter then you could charge an E&M for the facility with a 25 modifier.

    Debra A. Mitchell, MSPH, CPC-H

  5. #5


    Thank you!

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