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physician E&M service and facility infusion on the same day-
So in peds, often times, the physician ends up seeing the patient on the same day as infusion therapy that is billed by the facility.
Since the clinic and infusion suite is hospital owned, there is conflict on how the physician services should be billed.
following CPT guidelines, if there is a significant and separate identifiable E&M it should be billable, however, since both the infusion suite and physician clinic is hospital based/owned the POS for both location i believe would be 22. I know the facility is reporting an E&M + infusion codes, but would the physician E&M also be billed? If so, is it with modifier 25 or w/o? If not, is it because there is already an E&M code the facility is billing?
Thanks
Bilal
Thanks
Bilal
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Any help would be appreciated…
Mark…
I bill for a surgeon who sees patients at 2 different hospitals. I seem to be coming across a problem getting paid for emergency surgeries at one of these facilities. For example;
Patient goes to emergency room with RUQ pain and vomitting, etc. Surgeon is consulted, he performs h&p and decides to take patient to surgery for Laparoscopic Cholecystectomy. Patient is discharged the next day.
I bill this scenario fairly frequently for both hospitals with an outpatient e/m code (99203/4), modifier -57 for decision for surgery, and the surgery code (47562); all with place of service of 22 (outpatient). There is no pre-authorization to report since it is an emergency surgery.
I get paid without any problems for one hospital, but the other seems to always cause problems. The payer comes back saying pre-auth absent. When I call the hospital billing department, they tell me everything is in order, they were paid, and if a pre-auth was needed, it was in place. When I call the payer, they say "if the surgery was outpatient, it needs a pre-auth. If it was emergency it does not." but they don’t offer any additional information on where the hang-up is.
So my question is, what are the triggers in the hospital billing process to show that a surgery was an emergency and a pre-authorization should not be necessary for the performing surgeon? OR, am I billing this scenario properly? Sometimes, I do bill the h&p with the ER e/m code and pos (23), but the surgery is always with an outpatient pos.
What am I missing here? Any insight appreciated.
Thanks, Nancy