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FQHC's and 5010 conversion

  1. Default FQHC's and 5010 conversion
    Medical Coding Books
    I work for an FQHC, freestanding clinic. With the version 5010, FQHC's are now required to report priority (Type) of visit (Admission Type Code),Source of Admission and Patient Discharge status.
    I have been researching, however, and I have not been able to find much information on this.
    According to the information I have found, would the code W (not applicable) be appropriate for the priority type of visit?
    On the "source of admission" there seems to be no code which would be appropriate, since we are a family practice. However,referrals and transfers are not part of our practice. Code 9 "information not available", seems to be most appropriate as far as what is in the list.
    Patient discharge, code 01 "discharge to home or self care" seems to be the most appropriate. However, using this code seems wrong because we don't "discharge" patients. We see patients here in the office (not in a hospital setting) and do not admit or discharge them, so none of these codes seem applicable to us.
    Can anyone help with this, or direct me to where I may be able to find the information. I have searched on Medicare, our MAC and have done internet searches.


  2. #2
    Default FQHC Billing

    I worked in a FQHC for twelve years before moving on to a position where I am strictly coding now. However before I left, I ran into these same problems, and researched them myself and was getting paid on the claims before I left.

    You are correct in your research. I was using 9 "information not available" and "01" discharged home unless in the progress note I was informed that the patient was transported to hospital in that case, I believe there was another number to use. I done both the coding and billing at the FQHC so I had access to the information necessary to perform the job.

    Clinical Coder II

  3. Default
    I currently code for an FQHC and this is how we code those:

    01 - Discharge to Self Care

    03 - Elective Admission

    We leave the source code blank.

    We have been billing ours this way since December 2011 when we switched to 5010 and have been getting paid by Medicare.

    I agree with you that it makes no sense that we would have to include these codes since we are a family practice and not a facility, but nothing in FQHC billing seems logical!!!
    Laurie Wilson, CPC, CPMA

  4. Default
    Could anyone recomend a good resource manual for FQHC other than CMS website?

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