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Code G0463

Luz Posted Thu 03rd of September, 2015 14:23:22 PM

I need your input on the following. Can a sleep technologist bill code G043 as incident-to? My research indicates that G0463 is a facilities code, not an Office code. Therefore, I think, does not meet the incident-to requirement. We have never billed this code,so I need your expert advise. If possible, please tell me where to find good reliable information on this issue.

Thank You,

SuperCoder Answered Fri 04th of September, 2015 03:31:26 AM

Well, only a registered professional can report the service. Whereas, the code G0463 describes a hospital outpatient clinic visit for the assessment and management of a new or established patient, regardless of the level of effort. It applies to all outpatient clinic visits except emergency room visits. A hospital outpatient clinic provides services to patients who do not require overnight hospitalization. This is because effective Jan.1, 2014, when outpatient E/M services are paid under Medicare’s PHP and not in the physician office setting, the CPT® outpatient visit codes, 99201-99215, were replaced with one Level II HCPCS code, G0463 (Hospital outpatient clinic visit for assessment and management of a patient). Hope it helps!

Luz Posted Tue 08th of September, 2015 10:30:45 AM

Thank you for your response but I am not clear on this,please clarify. Can this service(code G0463), performed in the office, by a sleep technologist, be billed as incident to a physician service?

SuperCoder Answered Wed 09th of September, 2015 04:45:56 AM

Well, as I explained earlier, it can be billed with all outpatient clinic visits except emergency room visits. Just make sure that the physician is billing, should be qualified and registered. Hope it helps!

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