Wiki Outpatient facility coding for ED

[DevonaG]

Do the same guidelines for OP facility coding on UB04's pertain as profee 1500? I am new to auditing facility and wondered if the E/M's should have a 57 modifier and a 54 on procedure code 25605 - this is how they would be coded on the profee side. Also another encounter 26540 was performed on the left thumb - shouldn't it have FA instead of LT?

 

[Pam Warren]

No, they're not the same guidelines at all. The facility E&Ms are based on your organization's calculation of the resources used by hospital (facility) employees. Generally they have a tool that's used to calculate the resource use. CCI edits will apply, though. The -57 reports your physician's decision for major surgery, which doesn't apply to the facility E&M. The anatomic modifiers are generally payer specific, but the FA is more specific than LT, and I'd use that anyway.